- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $1,905.46 / $3,715.35
| Facility | | $67.61 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $93.33 / $281.84
| Professional | | $44.67 | $93.33 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $120.23 / $239.88 / $398.11
| Professional | 50 | $120.23 | $239.88 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $537.03 / $2,818.38
| Facility | | $56.23 | $537.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $93.33 / $229.09
| Professional | | $48.98 | $93.33 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $123.03
| Facility | | $52.48 | $52.48 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $100.00 / $181.97
| Professional | | $52.48 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $102.33 / $186.21
| Professional | | $56.23 | $102.33 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $177.83 / $7,079.46
| Facility | | $47.86 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $158.49
| Professional | | $100.00 | $125.89 | $158.49 |
- 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
- $47.86 / $104.71 / $223.87
| Professional | | $47.86 | $104.71 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $831.76 / $1,047.13
| Facility | | $63.10 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $141.25 / $354.81
| Professional | | $125.89 | $141.25 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $537.03 / $2,818.38
| Facility | | $56.23 | $537.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $93.33 / $229.09
| Professional | | $48.98 | $93.33 | $229.09 |
- 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
- $51.29 / $95.50 / $208.93
| Professional | | $51.29 | $95.50 | $208.93 |