- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,388.44 / $6,025.60
| Facility | | $1,000.00 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $758.58 / $1,819.70
| Professional | | $186.21 | $758.58 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $575.44 / $1,348.96
| Professional | | $239.88 | $575.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,778.28
| Professional | | $32.36 | $33.11 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,025.60 / $13,489.63
| Facility | | $5,128.61 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $1,023.29 / $1,621.81
| Professional | | $288.40 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $724.44 / $1,949.84
| Professional | | $213.80 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,000.00 / $1,584.89
| Professional | | $275.42 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $7,079.46
| Facility | | $1,995.26 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $616.60 / $1,318.26
| Professional | | $194.98 | $616.60 | $1,318.26 |