- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.42 / $1,662.00 / $5,691.00
| Facility | | $123.42 | $1,662.00 | $5,691.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.23 / $184.22 / $540.00
| Professional | | $89.23 | $184.22 | $540.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,958.00
| Facility | | $821.00 | $1,963.00 | $4,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.00 / $146.18 / $256.49
| Professional | | $95.00 | $146.18 | $256.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.64 / $204.99 / $394.32
| Professional | | $105.64 | $204.99 | $394.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.20 / $211.95 / $1,778.00
| Facility | | $68.20 | $211.95 | $1,778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.09 / $263.36 / $1,853.36
| Professional | | $154.09 | $263.36 | $1,853.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.00 / $1,410.00 / $2,675.00
| Facility | | $899.00 | $1,410.00 | $2,675.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.12 / $217.65 / $402.57
| Professional | | $148.12 | $217.65 | $402.57 |