- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,884.03 / $6,606.93
| Facility | | $630.96 | $2,884.03 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $323.59 / $1,122.02
| Professional | | $190.55 | $323.59 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $104.71 / $177.83
| Professional | | $83.18 | $104.71 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $363.08
| Professional | | $177.83 | $234.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $549.54
| Professional | | $204.17 | $295.12 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $3,162.28
| Facility | | $208.93 | $331.13 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $2,511.89
| Professional | | $288.40 | $363.08 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $4,786.30
| Facility | | $1,380.38 | $2,041.74 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $436.52
| Professional | | $199.53 | $288.40 | $436.52 |