- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.55 / $2,582.00 / $8,294.00
| Facility | | $136.55 | $2,582.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.31 / $176.86 / $272.52
| Professional | | $115.31 | $176.86 | $272.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.73 / $183.77 / $279.06
| Professional | | $117.73 | $183.77 | $279.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.66 / $139.65 / $3,026.00
| Professional | | $129.66 | $139.65 | $3,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.65 / $206.65 / $206.65
| Facility | | $206.65 | $206.65 | $206.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.71 / $189.85 / $334.77
| Professional | | $118.71 | $189.85 | $334.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.88 / $232.38 / $276.64
| Professional | | $206.88 | $232.38 | $276.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.30 / $178.53 / $267.37
| Facility | | $115.30 | $178.53 | $267.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.00 / $263.00 / $371.00
| Professional | | $230.00 | $263.00 | $371.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.58 / $149.34 / $2,156.00
| Facility | | $103.58 | $149.34 | $2,156.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.69 / $243.79 / $2,156.00
| Professional | | $160.69 | $243.79 | $2,156.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.00 / $1,890.00 / $3,765.00
| Facility | | $1,066.00 | $1,890.00 | $3,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.13 / $202.97 / $355.49
| Professional | | $139.13 | $202.97 | $355.49 |