- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.22 / $5,000.27 / $7,838.38
| Facility | | $191.22 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.75 / $176.50 / $324.81
| Professional | | $115.75 | $176.50 | $324.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.01 / $2,536.48 / $3,911.84
| Facility | | $728.01 | $2,536.48 | $3,911.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.97 / $203.13 / $336.78
| Professional | | $134.97 | $203.13 | $336.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.74 / $272.85
| Professional | | $32.34 | $32.74 | $272.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.02 / $189.87 / $261.50
| Facility | | $123.02 | $189.87 | $261.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.90 / $224.12 / $371.53
| Professional | | $136.90 | $224.12 | $371.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.00 / $2,516.00 / $3,893.88
| Facility | | $418.00 | $2,516.00 | $3,893.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.40 / $268.02 / $430.56
| Professional | | $194.40 | $268.02 | $430.56 |