- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $478.63 / $3,981.07
| Facility | | $102.33 | $478.63 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $120.23 / $398.11
| Professional | | $52.48 | $120.23 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $10,000.00
| Facility | | $1,548.82 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $125.89 / $239.88
| Professional | | $66.07 | $125.89 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $245.47 / $812.83
| Facility | | $56.23 | $245.47 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $125.89 / $263.03
| Professional | | $60.26 | $125.89 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $107.15 / $204.17
| Professional | | $52.48 | $107.15 | $204.17 |