- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $2,238.72 / $3,801.89
| Facility | | $97.72 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $114.82 / $257.04
| Professional | | $79.43 | $114.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $4,786.30
| Facility | | $56.23 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $165.96 / $398.11
| Professional | | $95.50 | $165.96 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $245.47
| Facility | | $107.15 | $107.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $186.21 / $346.74
| Professional | | $107.15 | $186.21 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $186.21 / $323.59
| Professional | | $102.33 | $186.21 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $181.97 / $7,079.46
| Facility | | $85.11 | $181.97 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $186.21 / $234.42
| Professional | | $147.91 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $331.13
| Professional | | $100.00 | $173.78 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $4,786.30
| Facility | | $56.23 | $1,949.84 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $165.96 / $398.11
| Professional | | $95.50 | $165.96 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $169.82 / $346.74
| Professional | | $100.00 | $169.82 | $346.74 |