- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.92 / $2,240.00 / $7,629.00
| Facility | | $29.92 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.26 / $28.54 / $40.10
| Professional | | $21.26 | $28.54 | $40.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.39 / $54.63 / $66.38
| Professional | | $32.39 | $54.63 | $66.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.95 / $33.15 / $57.77
| Professional | | $22.95 | $33.15 | $57.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.09 / $48.98 / $50.42
| Professional | | $38.09 | $48.98 | $50.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,564.67 / $2,564.67 / $2,564.67
| Facility | | $2,564.67 | $2,564.67 | $2,564.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.48 / $54.48 / $54.48
| Professional | | $54.48 | $54.48 | $54.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $8,017.00
| Facility | | $594.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.91 / $30.36 / $134.11
| Professional | | $21.91 | $30.36 | $134.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.29 / $37.29 / $42.40
| Professional | | $37.29 | $37.29 | $42.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.41 / $42.41 / $42.41
| Facility | | $42.41 | $42.41 | $42.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.04 / $33.61 / $60.52
| Professional | | $24.04 | $33.61 | $60.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.88 / $24.47 / $31.74
| Facility | | $22.88 | $24.47 | $31.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.60 / $30.39 / $33.47
| Professional | | $23.60 | $30.39 | $33.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.06 / $38.51 / $66.54
| Professional | | $30.06 | $38.51 | $66.54 |