- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $6,309.57 / $11,748.98
| Facility | | $104.71 | $6,309.57 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $19.05 / $56.23
| Professional | | $7.08 | $19.05 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.88 / $35.48
| Professional | | $25.12 | $33.88 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $190.55 / $302.00
| Facility | | $120.23 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $23.44 / $30.20
| Professional | | $19.95 | $23.44 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $12.88 / $33.11
| Professional | | $4.37 | $12.88 | $33.11 |