- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $3,162.28 / $7,762.47
| Facility | | $120.23 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $117.49 / $208.93
| Professional | | $102.33 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $120.23 / $1,380.38
| Professional | | $95.50 | $120.23 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $288.40
| Professional | | $102.33 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $100.00 / $234.42
| Professional | | $93.33 | $100.00 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,981.07 / $26,302.68
| Facility | | $1,023.29 | $3,981.07 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $114.82 / $251.19
| Professional | | $89.13 | $114.82 | $251.19 |