- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.21 / $16,391.24 / $25,553.25
| Facility | | $182.21 | $16,391.24 | $25,553.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $110.62 / $164.61
| Professional | | $106.33 | $110.62 | $164.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.58 / $174.29 / $463.11
| Facility | | $165.58 | $174.29 | $463.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.95 / $114.95 / $114.95
| Professional | | $114.95 | $114.95 | $114.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.32 / $106.33 / $458.00
| Facility | | $100.32 | $106.33 | $458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $106.33
| Professional | | $106.33 | $106.33 | $106.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.04 / $190.46 / $417.50
| Facility | | $136.04 | $190.46 | $417.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $151.44 / $1,358.07
| Professional | | $136.04 | $151.44 | $1,358.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $112.71 / $133.02
| Professional | | $106.33 | $112.71 | $133.02 |