- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $1,000.00 / $5,370.32
| Facility | | $102.33 | $1,000.00 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $102.33 / $251.19
| Professional | | $89.13 | $102.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $138.04 / $218.78
| Professional | | $117.49 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $190.55 / $295.12
| Professional | | $32.36 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $165.96 / $204.17
| Professional | | $128.82 | $165.96 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $158.49 / $213.80
| Professional | | $85.11 | $158.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $154.88 / $223.87
| Professional | | $125.89 | $154.88 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $120.23 / $208.93
| Professional | | $95.50 | $120.23 | $208.93 |