- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $2,818.38 / $8,709.64
| Facility | | $154.88 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $114.82 / $245.47
| Professional | | $81.28 | $114.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,570.88 / $10,232.93
| Facility | | $2,089.30 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $138.04 / $269.15
| Professional | | $91.20 | $138.04 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $173.78 / $933.25
| Facility | | $74.13 | $173.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $151.36 / $331.13
| Professional | | $95.50 | $151.36 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $120.23 / $229.09
| Professional | | $79.43 | $120.23 | $229.09 |