- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $7,943.28 / $16,595.87
| Facility | | $162.18 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $218.78 / $371.54
| Professional | | $131.83 | $218.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $1,000.00
| Facility | | $323.59 | $562.34 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $331.13
| Professional | | $138.04 | $218.78 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $245.47
| Facility | | $100.00 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $467.74
| Professional | | $154.88 | $257.04 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $575.44
| Professional | | $338.84 | $338.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $489.78
| Facility | | $144.54 | $257.04 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,202.26 / $3,548.13
| Facility | | $354.81 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $204.17 / $354.81
| Professional | | $123.03 | $204.17 | $354.81 |