- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.03 / $2,747.00 / $4,806.64
| Facility | | $65.03 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.23 / $161.81 / $335.85
| Professional | | $64.23 | $161.81 | $335.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.35 / $172.62 / $363.26
| Facility | | $90.35 | $172.62 | $363.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.43 / $283.38 / $1,237.14
| Professional | | $87.43 | $283.38 | $1,237.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.25 / $170.09 / $227.41
| Facility | | $96.25 | $170.09 | $227.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.63 / $156.33 / $426.44
| Professional | | $72.63 | $156.33 | $426.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.48 / $88.00 / $90.00
| Facility | | $83.48 | $88.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.89 / $209.33 / $534.46
| Professional | | $82.89 | $209.33 | $534.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.97 / $139.62 / $6,679.00
| Facility | | $69.97 | $139.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.11 / $232.94 / $386.99
| Professional | | $125.11 | $232.94 | $386.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.26 / $221.26 / $547.39
| Professional | | $93.26 | $221.26 | $547.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.26 / $363.26 / $363.26
| Facility | | $363.26 | $363.26 | $363.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.79 / $498.37 / $1,237.14
| Professional | | $203.79 | $498.37 | $1,237.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.33 / $300.72 / $795.72
| Professional | | $189.33 | $300.72 | $795.72 |