- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.40 / $2,293.00 / $6,615.96
| Facility | | $97.40 | $2,293.00 | $6,615.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.03 / $106.57 / $452.00
| Professional | | $88.03 | $106.57 | $452.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.46 / $106.33 / $157.31
| Professional | | $102.46 | $106.33 | $157.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.30 / $141.36 / $238.47
| Professional | | $110.30 | $141.36 | $238.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.16 / $168.48 / $168.48
| Professional | | $125.16 | $168.48 | $168.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.80 / $6,480.84 / $11,919.94
| Facility | | $670.80 | $6,480.84 | $11,919.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.94 / $1,628.16 / $8,541.66
| Facility | | $145.94 | $1,628.16 | $8,541.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.03 / $131.18 / $426.00
| Professional | | $88.03 | $131.18 | $426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $151.60 / $253.60
| Professional | | $5.00 | $151.60 | $253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.59 / $141.88 / $249.62
| Professional | | $109.59 | $141.88 | $249.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.48 / $100.48 / $140.00
| Facility | | $100.48 | $100.48 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.80 / $102.59 / $140.00
| Professional | | $95.80 | $102.59 | $140.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.04 / $128.71 / $208.75
| Professional | | $98.04 | $128.71 | $208.75 |