- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $37.15 / $87.10
| Professional | | $26.30 | $37.15 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $13,803.84 / $30,199.52
| Facility | | $3,162.28 | $13,803.84 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Professional | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $5,370.32
| Facility | | $2,238.72 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,445.44 / $2,089.30
| Facility | | $616.60 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $3,311.31
| Professional | | $147.91 | $147.91 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $1,949.84
| Facility | | $977.24 | $1,548.82 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $151.36
| Professional | | $147.91 | $147.91 | $151.36 |