- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $1,096.48 / $1,995.26
| Facility | | $114.82 | $1,096.48 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $257.04 / $812.83
| Professional | | $114.82 | $257.04 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $131.83 / $141.25
| Professional | | $102.33 | $131.83 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $190.55
| Facility | | $173.78 | $173.78 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $457.09 / $1,174.90
| Professional | | $131.83 | $457.09 | $1,174.90 |
- 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
- $489.78 / $1,000.00 / $1,949.84
| Facility | | $489.78 | $1,000.00 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $524.81 / $1,148.15
| Professional | | $134.90 | $524.81 | $1,148.15 |