- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,162.28 / $9,332.54
| Facility | | $501.19 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $131.83 / $302.00
| Professional | | $107.15 | $131.83 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,715.35 / $9,332.54
| Facility | | $1,584.89 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $151.36 / $281.84
| Professional | | $100.00 | $151.36 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $398.11 / $1,318.26
| Facility | | $194.98 | $398.11 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $181.97 / $389.05
| Professional | | $117.49 | $181.97 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,786.30
| Facility | | $562.34 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $147.91 / $269.15
| Professional | | $102.33 | $147.91 | $269.15 |