- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.81 / $3,818.00 / $7,007.00
| Facility | | $317.81 | $3,818.00 | $7,007.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.33 / $131.33 / $317.81
| Professional | | $131.33 | $131.33 | $317.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.16 / $152.27 / $3,944.00
| Professional | | $134.16 | $152.27 | $3,944.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.33 / $206.37 / $340.44
| Professional | | $130.33 | $206.37 | $340.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.58 / $303.70 / $303.70
| Professional | | $137.58 | $303.70 | $303.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.00 / $3,378.00 / $26,408.00
| Facility | | $2,648.00 | $3,378.00 | $26,408.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.08 / $300.56 / $343.84
| Professional | | $126.08 | $300.56 | $343.84 |