- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $1,778.28 / $8,511.38
| Facility | | $128.82 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $812.83
| Professional | | $95.50 | $134.90 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $114.82 / $144.54
| Professional | | $81.28 | $114.82 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $6,760.83 / $46,773.51
| Facility | | $457.09 | $6,760.83 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $5,888.44 / $10,471.29
| Professional | | $457.09 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $954.99 / $3,388.44
| Facility | | $389.05 | $954.99 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $295.12
| Professional | | $128.82 | $204.17 | $295.12 |