- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $275.42 / $7,585.78
| Facility | | $52.48 | $275.42 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $120.23 / $275.42
| Professional | | $45.71 | $120.23 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $117.49 / $229.09
| Professional | | $61.66 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $186.21
| Professional | | $56.23 | $100.00 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $173.78 / $457.09
| Professional | | $60.26 | $173.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $120.23 / $125.89
| Professional | | $41.69 | $120.23 | $125.89 |
- 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
- $56.23 / $104.71 / $218.78
| Professional | | $56.23 | $104.71 | $218.78 |