- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $3,388.44 / $5,623.41
| Facility | | $257.04 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $239.88 / $501.19
| Professional | | $177.83 | $239.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,981.07 / $6,309.57
| Facility | | $602.56 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $1,348.96
| Professional | | $218.78 | $346.74 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $346.74
| Professional | | $295.12 | $295.12 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $660.69
| Professional | | $257.04 | $446.68 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,981.07 / $6,309.57
| Facility | | $602.56 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $1,348.96
| Professional | | $218.78 | $346.74 | $1,348.96 |