- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.76 / $245.18 / $7,252.36
| Facility | | $100.76 | $245.18 | $7,252.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.51 / $168.58 / $293.39
| Professional | | $82.51 | $168.58 | $293.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.02 / $537.02 / $1,404.00
| Facility | | $537.02 | $537.02 | $1,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.85 / $161.43 / $328.10
| Professional | | $83.85 | $161.43 | $328.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,497.35 / $4,004.31 / $4,203.60
| Facility | | $3,497.35 | $4,004.31 | $4,203.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.70 / $106.70 / $386.89
| Professional | | $106.70 | $106.70 | $386.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $440.00 / $440.00
| Facility | | $250.00 | $440.00 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.54 / $197.26 / $498.31
| Professional | | $154.54 | $197.26 | $498.31 |