- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.07 / $7,340.00 / $13,413.92
| Facility | | $1,700.07 | $7,340.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.18 / $686.49 / $3,108.07
| Professional | | $130.18 | $686.49 | $3,108.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.61 / $582.74 / $1,921.61
| Professional | | $172.61 | $582.74 | $1,921.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.62 / $721.13 / $4,351.30
| Facility | | $166.62 | $721.13 | $4,351.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.56 / $1,085.83 / $3,809.80
| Professional | | $371.56 | $1,085.83 | $3,809.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.00 / $1,047.59 / $4,309.80
| Professional | | $480.00 | $1,047.59 | $4,309.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.62 / $721.13 / $4,351.30
| Facility | | $166.62 | $721.13 | $4,351.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.42 / $856.32 / $3,918.00
| Professional | | $283.42 | $856.32 | $3,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.00 / $1,665.86 / $4,595.01
| Professional | | $1,011.00 | $1,665.86 | $4,595.01 |