- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.16 / $128.16 / $264.14
| Facility | | $128.16 | $128.16 | $264.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.16 / $143.19 / $432.79
| Professional | | $128.16 | $143.19 | $432.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $41.23 / $242.70
| Facility | | $0.98 | $41.23 | $242.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.97 / $41.23 / $41.23
| Professional | | $32.97 | $41.23 | $41.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,468.21 / $6,336.48 / $15,243.25
| Facility | | $4,468.21 | $6,336.48 | $15,243.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.38 / $2,334.19 / $2,526.51
| Professional | | $1,989.38 | $2,334.19 | $2,526.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,518.28 / $5,793.06 / $12,002.56
| Facility | | $3,518.28 | $5,793.06 | $12,002.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.38 / $1,989.38 / $2,486.71
| Professional | | $1,989.38 | $1,989.38 | $2,486.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.55 / $526.50 / $2,170.19
| Facility | | $205.55 | $526.50 | $2,170.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,170.19 / $2,170.19 / $3,742.91
| Professional | | $2,170.19 | $2,170.19 | $3,742.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,170.19 / $2,170.19 / $3,906.36
| Professional | | $2,170.19 | $2,170.19 | $3,906.36 |