- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,754.23 / $7,413.10
| Facility | | $1,000.00 | $2,754.23 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $36.31 / $257.04
| Professional | | $18.20 | $36.31 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $1,000.00 / $1,288.25
| Professional | | $57.54 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.88 / $40.74
| Professional | | $32.36 | $33.88 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $181.97 / $1,288.25
| Facility | | $28.18 | $181.97 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $977.24 / $1,862.09
| Professional | | $26.30 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $602.56 / $1,380.38
| Facility | | $45.71 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $891.25 / $1,659.59
| Professional | | $26.30 | $891.25 | $1,659.59 |