- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,344.23 / $7,762.47
| Facility | | $741.31 | $2,344.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $61.66 / $85.11
| Professional | | $34.67 | $61.66 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,000.00 / $1,202.26
| Facility | | $436.52 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,445.44 / $3,801.89
| Facility | | $562.34 | $1,445.44 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $60.26 / $181.97
| Professional | | $43.65 | $60.26 | $181.97 |