- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $724.44 / $1,819.70
| Facility | | $309.03 | $724.44 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $162.18 / $467.74
| Professional | | $120.23 | $162.18 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $1,230.27 / $1,621.81
| Facility | | $52.48 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $50.12
| Professional | | $0.02 | $0.02 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $912.01 / $1,819.70
| Facility | | $398.11 | $912.01 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $1,288.25
| Facility | | $302.00 | $602.56 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $60.26 / $69.18
| Professional | | $47.86 | $60.26 | $69.18 |