- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,890.45 / $5,495.41
| Facility | | $776.25 | $3,890.45 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $691.83 / $1,348.96
| Professional | | $223.87 | $691.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,754.23 / $4,897.79
| Facility | | $1,584.89 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,047.13 / $1,380.38
| Professional | | $407.38 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $562.34 / $1,318.26
| Professional | | $275.42 | $562.34 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $776.25 / $2,511.89
| Facility | | $281.84 | $776.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $588.84 / $1,548.82
| Professional | | $257.04 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,890.45 / $6,025.60
| Facility | | $2,754.23 | $3,890.45 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,479.11
| Professional | | $346.74 | $602.56 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $741.31 / $3,019.95
| Professional | | $223.87 | $741.31 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $630.96 / $1,288.25
| Professional | | $263.03 | $630.96 | $1,288.25 |