- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.56 / $1,886.00 / $3,363.00
| Facility | | $80.56 | $1,886.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.47 / $163.98 / $236.53
| Professional | | $79.47 | $163.98 | $236.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.04 / $784.12 / $4,569.00
| Facility | | $115.04 | $784.12 | $4,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.05 / $300.05 / $1,103.77
| Professional | | $113.05 | $300.05 | $1,103.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.22 / $119.79 / $234.21
| Facility | | $93.22 | $119.79 | $234.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.50 / $259.04 / $509.57
| Professional | | $126.50 | $259.04 | $509.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.89 / $289.44 / $748.00
| Facility | | $229.89 | $289.44 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.57 / $257.58 / $531.11
| Professional | | $109.57 | $257.58 | $531.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $377.00 / $6,679.00
| Facility | | $83.43 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.49 / $288.27 / $431.37
| Professional | | $222.49 | $288.27 | $431.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.92 / $236.34 / $524.70
| Professional | | $120.92 | $236.34 | $524.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,267.00 / $4,755.00
| Facility | | $55.00 | $1,267.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.88 / $427.06 / $1,381.36
| Professional | | $226.88 | $427.06 | $1,381.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.87 / $310.22 / $680.64
| Professional | | $212.87 | $310.22 | $680.64 |