- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $1,096.48
| Facility | | $436.52 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $954.99
| Professional | | $30.20 | $47.86 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $602.56 / $912.01
| Professional | | $363.08 | $602.56 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $2,238.72 / $3,981.07
| Facility | | $33.11 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $21.88 / $89.13
| Professional | | $7.08 | $21.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $61.66 / $100.00
| Professional | | $39.81 | $61.66 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $4,365.16
| Professional | | $2,041.74 | $2,041.74 | $4,365.16 |