- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,659.59 / $6,918.31
| Facility | | $173.78 | $1,659.59 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $562.34 / $1,380.38
| Professional | | $125.89 | $562.34 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $162.18 / $1,122.02
| Professional | | $117.49 | $162.18 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $851.14 / $1,995.26
| Professional | | $173.78 | $851.14 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $812.83 / $3,235.94
| Facility | | $223.87 | $812.83 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $426.58 / $1,445.44
| Professional | | $162.18 | $426.58 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $512.86 / $1,071.52
| Facility | | $128.82 | $512.86 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $562.34 / $1,819.70
| Professional | | $3.98 | $562.34 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $14,125.38
| Facility | | $1,148.15 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $501.19 / $1,202.26
| Professional | | $134.90 | $501.19 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $9,549.93 / $9,549.93
| Facility | | $56.23 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $5,128.61
| Professional | | $4,365.16 | $4,365.16 | $5,128.61 |