- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $4,897.79 / $16,595.87
| Facility | | $208.93 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $104.71 / $1,122.02
| Professional | | $66.07 | $104.71 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $69.18 / $107.15
| Professional | | $63.10 | $69.18 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $67.61 / $158.49
| Professional | | $58.88 | $67.61 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $104.71 / $158.49
| Professional | | $79.43 | $104.71 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $109.65 / $208.93
| Facility | | $66.07 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $91.20 / $147.91
| Professional | | $70.79 | $91.20 | $147.91 |