- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $3,162.28 / $7,762.47
| Facility | | $120.23 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $112.20 / $199.53
| Professional | | $95.50 | $112.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $123.03 / $4,073.80
| Professional | | $97.72 | $123.03 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $117.49 / $346.74
| Professional | | $83.18 | $117.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $107.15 / $234.42
| Professional | | $102.33 | $107.15 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $10,000.00 / $26,302.68
| Facility | | $2,344.23 | $10,000.00 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $112.20 / $251.19
| Professional | | $83.18 | $112.20 | $251.19 |