- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.09 / $2,351.21 / $7,264.38
| Facility | | $174.09 | $2,351.21 | $7,264.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.41 / $145.37 / $255.26
| Professional | | $102.41 | $145.37 | $255.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,786.00 / $8,800.00
| Facility | | $1,145.00 | $2,786.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.54 / $134.62 / $235.48
| Professional | | $91.54 | $134.62 | $235.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.69 / $165.54 / $165.54
| Facility | | $113.69 | $165.54 | $165.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.72 / $170.91 / $170.91
| Professional | | $125.72 | $170.91 | $170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.03 / $172.76 / $279.37
| Professional | | $117.03 | $172.76 | $279.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.70 / $1,905.81 / $9,022.79
| Facility | | $1,225.70 | $1,905.81 | $9,022.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.33 / $179.21 / $271.89
| Professional | | $117.33 | $179.21 | $271.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.45 / $163.91 / $241.21
| Professional | | $117.45 | $163.91 | $241.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,551.00 / $5,235.00
| Facility | | $1,689.00 | $2,551.00 | $5,235.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.27 / $175.03 / $296.10
| Professional | | $131.27 | $175.03 | $296.10 |