- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $81.28 / $81.28
| Facility | | $39.81 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $79.43 / $144.54
| Professional | | $39.81 | $79.43 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $331.13 / $2,818.38
| Facility | | $56.23 | $331.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $100.00 / $269.15
| Professional | | $46.77 | $100.00 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $120.23
| Facility | | $51.29 | $51.29 | $120.23 |
- 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
- $53.70 / $104.71 / $208.93
| Professional | | $53.70 | $104.71 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $83.18 / $7,079.46
| Facility | | $46.77 | $83.18 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $181.97
| Professional | | $114.82 | $141.25 | $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
- $46.77 / $102.33 / $251.19
| Professional | | $46.77 | $102.33 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $331.13 / $2,818.38
| Facility | | $56.23 | $331.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $100.00 / $269.15
| Professional | | $46.77 | $100.00 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,819.70 / $2,818.38
| Facility | | $407.38 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $100.00 / $234.42
| Professional | | $47.86 | $100.00 | $234.42 |