- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $4,570.88 / $11,481.54
| Facility | | $186.21 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $125.89 / $229.09
| Professional | | $107.15 | $125.89 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,471.29 / $20,892.96
| Facility | | $3,630.78 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $269.15
| Professional | | $104.71 | $151.36 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $309.03 / $891.25
| Facility | | $120.23 | $309.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $331.13
| Professional | | $114.82 | $177.83 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $257.04
| Professional | | $100.00 | $147.91 | $257.04 |