- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.36 / $1,141.59 / $1,602.66
| Facility | | $35.36 | $1,141.59 | $1,602.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $1,018.43 / $1,343.06
| Professional | | $29.53 | $1,018.43 | $1,343.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.24 / $1,085.68 / $2,490.28
| Professional | | $32.24 | $1,085.68 | $2,490.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.61 / $46.61 / $46.61
| Facility | | $46.61 | $46.61 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.59 / $1,033.31 / $1,611.67
| Facility | | $39.59 | $1,033.31 | $1,611.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.51 / $1,033.31 / $2,723.34
| Professional | | $991.51 | $1,033.31 | $2,723.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.46 / $1,070.30 / $2,191.46
| Professional | | $35.46 | $1,070.30 | $2,191.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.54 / $1,211.67 / $2,059.61
| Professional | | $960.54 | $1,211.67 | $2,059.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.48 / $177.48 / $177.48
| Facility | | $177.48 | $177.48 | $177.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.74 / $7,170.93 / $10,233.90
| Professional | | $222.74 | $7,170.93 | $10,233.90 |