- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.07 / $202.47 / $1,098.32
| Facility | | $195.07 | $202.47 | $1,098.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.07 / $202.47 / $246.92
| Professional | | $195.07 | $202.47 | $246.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.71 / $222.23 / $259.51
| Facility | | $153.71 | $222.23 | $259.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $45.77 / $45.77
| Professional | | $38.90 | $45.77 | $45.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.92 / $407.42 / $41,999.58
| Facility | | $246.92 | $407.42 | $41,999.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.61 / $345.69 / $4,577.92
| Professional | | $271.61 | $345.69 | $4,577.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.50 / $188.43 / $296.30
| Facility | | $160.50 | $188.43 | $296.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.74 / $354.66 / $1,190.15
| Professional | | $277.74 | $354.66 | $1,190.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.71 / $148.15 / $296.30
| Professional | | $103.71 | $148.15 | $296.30 |