- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,370.32 / $10,715.19
| Facility | | $3,090.30 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $95.50 / $112.20
| Professional | | $57.54 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $141.25 / $229.09
| Professional | | $104.71 | $141.25 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $147.91 / $489.78
| Professional | | $123.03 | $147.91 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $104.71 / $109.65
| Professional | | $51.29 | $104.71 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,479.11 / $2,691.53
| Facility | | $676.08 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $131.83 / $239.88
| Professional | | $100.00 | $131.83 | $239.88 |