- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $2,818.38 / $5,623.41
| Facility | | $38.90 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $199.53
| Professional | | $41.69 | $66.07 | $199.53 |
- 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
- $56.23 / $97.72 / $229.09
| Professional | | $56.23 | $97.72 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $138.04
| Facility | | $60.26 | $60.26 | $138.04 |
- 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
- $57.54 / $100.00 / $199.53
| Professional | | $57.54 | $100.00 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $177.83 / $7,079.46
| Facility | | $53.70 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $120.23 / $173.78
| Professional | | $93.33 | $120.23 | $173.78 |
- 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
- $53.70 / $107.15 / $229.09
| Professional | | $53.70 | $107.15 | $229.09 |
- 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
- $56.23 / $97.72 / $239.88
| Professional | | $56.23 | $97.72 | $239.88 |
- 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
- $54.95 / $100.00 / $199.53
| Professional | | $54.95 | $100.00 | $199.53 |