- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $2,754.23 / $50,118.72
| Facility | | $109.65 | $2,754.23 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $52.48 / $138.04
| Professional | | $9.77 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $426.58 / $2,691.53
| Professional | | $63.10 | $426.58 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $57.54 / $107.15
| Professional | | $43.65 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $95.50 / $95.50
| Professional | | $87.10 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $549.54 / $5,888.44
| Facility | | $165.96 | $549.54 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $63.10 / $120.23
| Professional | | $40.74 | $63.10 | $120.23 |