- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,454.71 / $3,090.30
| Facility | | $218.78 | $2,454.71 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $245.47 / $831.76
| Professional | | $83.18 | $245.47 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,630.78 / $7,413.10
| Facility | | $851.14 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $371.54 / $1,000.00
| Professional | | $154.88 | $371.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,122.02 / $2,691.53
| Facility | | $691.83 | $1,122.02 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $398.11 / $1,230.27
| Professional | | $165.96 | $398.11 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $2,137.96
| Facility | | $870.96 | $1,071.52 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $501.19 / $1,122.02
| Professional | | $186.21 | $501.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $331.13 / $1,949.84
| Facility | | $100.00 | $331.13 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $616.60 / $2,238.72
| Professional | | $302.00 | $616.60 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $6,456.54
| Facility | | $1,000.00 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $309.03 / $870.96
| Professional | | $102.33 | $309.03 | $870.96 |