- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.63 / $2,145.78 / $7,838.38
| Facility | | $674.63 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.07 / $348.30 / $848.10
| Professional | | $63.07 | $348.30 | $848.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.26 / $2,292.44 / $3,738.69
| Facility | | $930.26 | $2,292.44 | $3,738.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.06 / $573.95 / $794.38
| Professional | | $78.06 | $573.95 | $794.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.56 / $111.56 / $596.36
| Facility | | $111.56 | $111.56 | $596.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.06 / $155.54 / $1,119.15
| Professional | | $78.06 | $155.54 | $1,119.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $157.88 / $820.77
| Professional | | $32.34 | $157.88 | $820.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.39 / $504.32 / $1,059.27
| Facility | | $62.39 | $504.32 | $1,059.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.79 / $540.20 / $1,311.15
| Professional | | $78.79 | $540.20 | $1,311.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $5,060.00
| Facility | | $755.00 | $3,085.00 | $5,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.04 / $1,012.50 / $1,397.25
| Professional | | $677.04 | $1,012.50 | $1,397.25 |