- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,388.44 / $6,025.60
| Facility | | $181.97 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $138.04 / $288.40
| Professional | | $107.15 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $177.83 / $275.42
| Professional | | $147.91 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $645.65
| Professional | | $32.36 | $33.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $616.60
| Professional | | $199.53 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $295.12 / $398.11
| Professional | | $112.20 | $295.12 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $218.78 / $302.00
| Professional | | $181.97 | $218.78 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $147.91 / $263.03
| Professional | | $114.82 | $147.91 | $263.03 |