- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $1,047.13 / $3,715.35
| Facility | | $107.15 | $1,047.13 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $154.88 / $263.03
| Professional | | $100.00 | $154.88 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $346.74
| Facility | | $331.13 | $331.13 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $281.84
| Professional | | $112.20 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,000.00 / $1,949.84
| Facility | | $478.63 | $1,000.00 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $181.97 / $338.84
| Professional | | $109.65 | $181.97 | $338.84 |