- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $1,122.02 / $1,122.02
| Facility | | $44.67 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $660.69 / $1,122.02
| Professional | | $72.44 | $660.69 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $1,202.26 / $3,630.78
| Professional | | $120.23 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $43.65 / $616.60
| Professional | | $35.48 | $43.65 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $58.88 / $69.18
| Professional | | $58.88 | $58.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $77.62 / $138.04
| Professional | | $50.12 | $77.62 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $1,230.27 / $3,630.78
| Professional | | $107.15 | $1,230.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $977.24 / $1,778.28
| Facility | | $199.53 | $977.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $1,047.13 / $1,621.81
| Professional | | $57.54 | $1,047.13 | $1,621.81 |