- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,981.07 / $9,332.54
| Facility | | $812.83 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $134.90 / $288.40
| Professional | | $112.20 | $134.90 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,659.59 / $1,995.26
| Facility | | $223.87 | $1,659.59 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $181.97 / $323.59
| Professional | | $114.82 | $181.97 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,715.19 / $21,379.62
| Facility | | $5,370.32 | $10,715.19 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $91.20 / $141.25
| Professional | | $85.11 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $165.96
| Professional | | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,623.41 / $9,772.37
| Facility | | $1,737.80 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $162.18 / $281.84
| Professional | | $109.65 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $120.23
| Professional | | $100.00 | $100.00 | $120.23 |