- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.32 / $186.07 / $10,976.87
| Facility | | $106.32 | $186.07 | $10,976.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $163.25
| Professional | | $106.33 | $106.33 | $163.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.60 / $317.39 / $1,433.35
| Facility | | $163.60 | $317.39 | $1,433.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $111.65 / $1,358.07
| Professional | | $106.33 | $111.65 | $1,358.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.99 / $130.57 / $239.77
| Facility | | $113.99 | $130.57 | $239.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $153.46
| Facility | | $106.33 | $106.33 | $153.46 |
- 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
- $106.33 / $214.94 / $8,090.00
| Facility | | $106.33 | $214.94 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $236.18 / $277.86
| Professional | | $106.33 | $236.18 | $277.86 |
- 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
- $2,933.16 / $2,933.16 / $2,933.16
| Facility | | $2,933.16 | $2,933.16 | $2,933.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.50 / $1,433.35 / $1,433.35
| Facility | | $417.50 | $1,433.35 | $1,433.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $112.71 / $1,358.07
| Professional | | $106.33 | $112.71 | $1,358.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $112.71 / $330.12
| Professional | | $106.33 | $112.71 | $330.12 |