- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $1,698.24 / $6,918.31
| Facility | | $194.98 | $1,698.24 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $831.76 / $2,454.71
| Professional | | $114.82 | $831.76 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $114.82 / $2,187.76
| Professional | | $53.70 | $114.82 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $1,071.52 / $2,454.71
| Professional | | $151.36 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $512.86 / $35,481.34
| Facility | | $204.17 | $512.86 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $457.09 / $2,454.71
| Professional | | $141.25 | $457.09 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $794.33 / $1,862.09
| Facility | | $114.82 | $794.33 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $2,344.23 / $3,630.78
| Professional | | $6.03 | $2,344.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,230.27 / $3,311.31
| Facility | | $251.19 | $1,230.27 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $758.58 / $1,621.81
| Professional | | $117.49 | $758.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,715.35 / $3,715.35
| Facility | | $56.23 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $10,232.93
| Professional | | $8,511.38 | $8,511.38 | $10,232.93 |