- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.58 / $902.04 / $3,573.53
| Facility | | $220.58 | $902.04 | $3,573.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.44 / $365.80 / $864.60
| Professional | | $206.44 | $365.80 | $864.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.02 / $1,088.02 / $1,088.02
| Facility | | $1,088.02 | $1,088.02 | $1,088.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.00 / $983.00 / $983.00
| Professional | | $983.00 | $983.00 | $983.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.42 / $1,173.42 / $2,668.68
| Facility | | $1,061.42 | $1,173.42 | $2,668.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.43 / $361.38 / $775.05
| Professional | | $214.43 | $361.38 | $775.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.43 / $458.19 / $894.08
| Professional | | $352.43 | $458.19 | $894.08 |