- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,041.74 / $6,456.54
| Facility | | $831.76 | $2,041.74 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $537.03 / $4,073.80
| Professional | | $263.03 | $537.03 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $281.84
| Professional | | $275.42 | $275.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,467.37 / $5,495.41
| Facility | | $2,187.76 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $2,630.27 / $3,630.78
| Professional | | $263.03 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $645.65 / $3,630.78
| Professional | | $275.42 | $645.65 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,949.84 / $4,073.80
| Facility | | $281.84 | $1,949.84 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $3,019.95 / $17,782.79
| Professional | | $630.96 | $3,019.95 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,949.84 / $3,467.37
| Facility | | $524.81 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $524.81 / $3,388.44
| Professional | | $257.04 | $524.81 | $3,388.44 |