- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $436.52 / $3,388.44
| Facility | | $63.10 | $436.52 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $100.00 / $281.84
| Professional | | $47.86 | $100.00 | $281.84 |
- 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
- $58.88 / $102.33 / $251.19
| Professional | | $58.88 | $102.33 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $151.36
| Facility | | $66.07 | $66.07 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $100.00 / $151.36
| Professional | | $64.57 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $120.23 / $213.80
| Professional | | $67.61 | $120.23 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $177.83 / $7,079.46
| Facility | | $56.23 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $181.97
| Professional | | $100.00 | $125.89 | $181.97 |
- 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
- $66.07 / $112.20 / $239.88
| Professional | | $66.07 | $112.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $213.80 / $575.44
| Facility | | $134.90 | $213.80 | $575.44 |
- 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
- $58.88 / $102.33 / $257.04
| Professional | | $58.88 | $102.33 | $257.04 |
- 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
- $60.26 / $107.15 / $208.93
| Professional | | $60.26 | $107.15 | $208.93 |