- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,348.96
| Facility | | $524.81 | $776.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $1,174.90
| Professional | | $30.20 | $47.86 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $1,122.02
| Professional | | $446.68 | $758.58 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $2,238.72 / $3,981.07
| Facility | | $41.69 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $20.89 / $85.11
| Professional | | $7.94 | $20.89 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $61.66 / $100.00
| Professional | | $39.81 | $61.66 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,248.07 / $5,248.07
| Professional | | $2,454.71 | $5,248.07 | $5,248.07 |