- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,000.00 / $3,467.37
| Facility | | $186.21 | $1,000.00 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $489.78
| Professional | | $186.21 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $208.93
| Professional | | $104.71 | $104.71 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,023.29
| Facility | | $741.31 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $338.84 / $537.03
| Professional | | $181.97 | $338.84 | $537.03 |
- 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
- $630.96 / $1,479.11 / $3,090.30
| Facility | | $630.96 | $1,479.11 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $489.78
| Professional | | $208.93 | $323.59 | $489.78 |