- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $1,258.93
| Facility | | $870.96 | $1,096.48 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $72.44 / $1,412.54
| Professional | | $34.67 | $72.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $57.54 / $112.20
| Facility | | $44.67 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,202.26 / $1,513.56
| Professional | | $1,122.02 | $1,202.26 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $81.28 / $3,467.37
| Facility | | $43.65 | $81.28 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $64.57 / $3,630.78
| Professional | | $47.86 | $64.57 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $17.38 / $22.91
| Professional | | $15.14 | $17.38 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $61.66 / $81.28
| Professional | | $46.77 | $61.66 | $81.28 |