- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $2,089.30 / $3,801.89
| Facility | | $52.48 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $64.57 / $263.03
| Professional | | $38.02 | $64.57 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $309.03 / $2,818.38
| Facility | | $56.23 | $309.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $91.20 / $223.87
| Professional | | $46.77 | $91.20 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $114.82
| Facility | | $48.98 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $91.20 / $194.98
| Professional | | $48.98 | $91.20 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $177.83 / $7,079.46
| Facility | | $46.77 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $117.49 / $169.82
| Professional | | $91.20 | $117.49 | $169.82 |
- 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
- $46.77 / $100.00 / $218.78
| Professional | | $46.77 | $100.00 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $275.42 / $2,818.38
| Facility | | $56.23 | $275.42 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $91.20 / $223.87
| Professional | | $46.77 | $91.20 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $93.33 / $186.21
| Professional | | $48.98 | $93.33 | $186.21 |