- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,000.00 / $7,585.78
| Facility | | $208.93 | $1,000.00 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $141.25 / $346.74
| Professional | | $120.23 | $141.25 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $380.19
| Professional | | $151.36 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $316.23
| Professional | | $144.54 | $204.17 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $177.83 / $331.13
| Facility | | $123.03 | $177.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $295.12 / $407.38
| Professional | | $3.02 | $295.12 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,137.96 / $4,265.80
| Facility | | $933.25 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $154.88 / $288.40
| Professional | | $120.23 | $154.88 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $19,498.45
| Facility | | $3,981.07 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $1,995.26
| Professional | | $1,348.96 | $1,995.26 | $1,995.26 |