- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,454.71 / $6,606.93
| Facility | | $676.08 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $331.13 / $724.44
| Professional | | $93.33 | $331.13 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $87.10 / $131.83
| Professional | | $50.12 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Professional | 50 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $8,912.51
| Facility | | $3,467.37 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $562.34 / $758.58
| Professional | | $97.72 | $562.34 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $158.49 / $724.44
| Professional | | $112.20 | $158.49 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $724.44 / $3,548.13
| Facility | | $112.20 | $724.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $4,365.16
| Professional | | $467.74 | $630.96 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,348.96 / $2,754.23
| Facility | | $371.54 | $1,348.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $251.19 / $676.08
| Professional | | $93.33 | $251.19 | $676.08 |