- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.70 / $1,861.55 / $2,071.06
| Facility | | $475.70 | $1,861.55 | $2,071.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $475.70 / $1,046.54
| Professional | | $407.74 | $475.70 | $1,046.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.11 / $1,182.45 / $3,227.96
| Facility | | $502.11 | $1,182.45 | $3,227.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $679.57 / $2,551.81
| Professional | | $407.74 | $679.57 | $2,551.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.32 / $1,454.16 / $2,700.90
| Facility | | $152.32 | $1,454.16 | $2,700.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.20 / $625.20 / $625.20
| Professional | | $625.20 | $625.20 | $625.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.72 / $485.89 / $1,324.89
| Facility | | $441.72 | $485.89 | $1,324.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.55 / $717.07 / $3,033.08
| Professional | | $397.55 | $717.07 | $3,033.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.64 / $980.64 / $1,153.70
| Professional | | $980.64 | $980.64 | $1,153.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.57 / $679.57 / $2,079.48
| Professional | | $679.57 | $679.57 | $2,079.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.45 / $3,227.96 / $3,227.96
| Facility | | $1,182.45 | $3,227.96 | $3,227.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.81 / $407.74 / $3,397.85
| Professional | | $305.81 | $407.74 | $3,397.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.42 / $407.74 / $1,404.54
| Professional | | $285.42 | $407.74 | $1,404.54 |