- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $1,000.00 / $7,585.78
| Facility | | $114.82 | $1,000.00 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $436.52
| Professional | | $114.82 | $165.96 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $251.19
| Professional | | $144.54 | $186.21 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $309.03
| Professional | | $158.49 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $812.83
| Professional | | $162.18 | $223.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $154.88 / $162.18
| Professional | | $114.82 | $154.88 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $3,890.45
| Facility | | $1,258.93 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $354.81
| Professional | | $162.18 | $218.78 | $354.81 |