- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,548.13 / $8,912.51
| Facility | | $467.74 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $269.15 / $537.03
| Professional | | $223.87 | $269.15 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,128.61 / $6,606.93
| Facility | | $2,454.71 | $5,128.61 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $501.19
| Professional | | $218.78 | $338.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $1,096.48
| Professional | | $251.19 | $389.05 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $302.00 / $323.59
| Professional | | $281.84 | $302.00 | $323.59 |
- 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
- $1,288.25 / $3,548.13 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $524.81
| Professional | | $245.47 | $323.59 | $524.81 |