- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $2,691.53 / $5,623.41
| Facility | | $28.18 | $2,691.53 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $93.33 / $263.03
| Professional | | $32.36 | $93.33 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $562.34 / $2,818.38
| Facility | | $56.23 | $562.34 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $89.13 / $302.00
| Professional | | $39.81 | $89.13 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $97.72
| Facility | | $41.69 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $107.15 / $275.42
| Professional | | $41.69 | $107.15 | $275.42 |
- 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
- $40.74 / $100.00 / $263.03
| Professional | | $40.74 | $100.00 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $83.18 / $7,079.46
| Facility | | $38.02 | $83.18 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $199.53
| Professional | | $109.65 | $141.25 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $104.71 / $263.03
| Professional | | $39.81 | $104.71 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $281.84
| Facility | | $138.04 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $138.04 / $169.82
| Professional | | $63.10 | $138.04 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $562.34 / $2,818.38
| Facility | | $56.23 | $562.34 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $89.13 / $309.03
| Professional | | $39.81 | $89.13 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $85.11 / $234.42
| Professional | | $41.69 | $85.11 | $234.42 |