- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.04 / $136.04 / $7,189.00
| Facility | | $136.04 | $136.04 | $7,189.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $136.04 / $3,078.19
| Professional | | $106.33 | $136.04 | $3,078.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.32 / $100.32 / $106.33
| Facility | | $100.32 | $100.32 | $106.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $106.33
| Professional | | $106.33 | $106.33 | $106.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.97 / $136.04 / $190.08
| Facility | | $116.97 | $136.04 | $190.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $112.71 / $132.91
| Professional | | $106.33 | $112.71 | $132.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.41 / $122.00 / $319.02
| Professional | | $93.41 | $122.00 | $319.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.50 / $224.17 / $423.43
| Facility | | $118.50 | $224.17 | $423.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.96 / $127.60 / $127.60
| Professional | | $116.96 | $127.60 | $127.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $112.71
| Professional | | $106.33 | $106.33 | $112.71 |