- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $1,000.00 / $7,585.78
| Facility | | $123.03 | $1,000.00 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $89.13 / $229.09
| Professional | | $77.62 | $89.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $229.09
| Professional | | $112.20 | $186.21 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $204.17
| Professional | | $100.00 | $141.25 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $123.03 / $218.78
| Facility | | $77.62 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $194.98
| Professional | | $131.83 | $173.78 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $117.49 / $194.98
| Professional | | $79.43 | $117.49 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $1,288.25
| Facility | | $56.23 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $630.96
| Professional | | $616.60 | $616.60 | $630.96 |