- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,479.11 / $4,365.16
| Facility | | $56.23 | $1,479.11 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $1,071.52 / $2,570.40
| Professional | | $56.23 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $134.90 / $3,801.89
| Professional | | $102.33 | $134.90 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $831.76 / $2,290.87
| Facility | | $38.02 | $831.76 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,995.26 / $4,570.88
| Professional | | $1,230.27 | $1,995.26 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $3,235.94
| Professional | | $131.83 | $131.83 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $1,778.28 / $2,454.71
| Professional | | $70.79 | $1,778.28 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $1,202.26 / $3,630.78
| Professional | | $67.61 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $100.00 / $2,884.03
| Professional | | $81.28 | $100.00 | $2,884.03 |