- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $3,162.28 / $5,128.61
| Facility | | $107.15 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $107.15 / $245.47
| Professional | | $70.79 | $107.15 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $16,982.44
| Facility | | $4,897.79 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $158.49 / $645.65
| Professional | | $89.13 | $158.49 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $123.03 / $831.76
| Facility | | $34.67 | $123.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $138.04 / $316.23
| Professional | | $77.62 | $138.04 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $10,000.00
| Facility | | $2,089.30 | $3,890.45 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $117.49 / $239.88
| Professional | | $74.13 | $117.49 | $239.88 |