- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.12 / $5,087.00 / $8,920.00
| Facility | | $173.12 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.91 / $156.65 / $221.45
| Professional | | $125.91 | $156.65 | $221.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,266.00 / $8,669.00 / $11,373.00
| Facility | | $6,266.00 | $8,669.00 | $11,373.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.22 / $158.16 / $220.45
| Professional | | $124.22 | $158.16 | $220.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.07 / $217.84 / $8,031.00
| Professional | | $150.07 | $217.84 | $8,031.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.32 / $195.22 / $316.70
| Professional | | $135.32 | $195.22 | $316.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.30 / $152.76 / $188.40
| Professional | | $127.30 | $152.76 | $188.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.65 / $192.84 / $292.57
| Facility | | $156.65 | $192.84 | $292.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.00 / $204.49 / $313.44
| Professional | | $169.00 | $204.49 | $313.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.69 / $192.79 / $9,929.00
| Facility | | $143.69 | $192.79 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.69 / $192.79 / $9,929.00
| Professional | | $143.69 | $192.79 | $9,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.06 / $206.21 / $303.20
| Professional | | $123.06 | $206.21 | $303.20 |