- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $1,000.00 / $3,890.45
| Facility | | $46.77 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $57.54 / $81.28
| Professional | | $45.71 | $57.54 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $56.23 / $134.90
| Professional | | $47.86 | $56.23 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $67.61 / $79.43
| Facility | | $47.86 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $66.07 / $81.28
| Professional | | $48.98 | $66.07 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $91.20 / $1,318.26
| Facility | | $64.57 | $91.20 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $91.20 / $676.08
| Professional | | $54.95 | $91.20 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $3,162.28
| Facility | | $50.12 | $602.56 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $69.18 / $104.71
| Professional | | $47.86 | $69.18 | $104.71 |