- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $2,818.38 / $5,623.41
| Facility | | $52.48 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $97.72 / $112.20
| Professional | | $52.48 | $97.72 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,862.09 / $3,467.37
| Facility | | $616.60 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $141.25 / $758.58
| Professional | | $93.33 | $141.25 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $165.96
| Professional | | $141.25 | $141.25 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $281.84
| Professional | | $109.65 | $194.98 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,862.09 / $3,467.37
| Facility | | $616.60 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $144.54 / $758.58
| Professional | | $93.33 | $144.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $141.25 / $295.12
| Professional | | $93.33 | $141.25 | $295.12 |