- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $2,089.30 / $3,715.35
| Facility | | $104.71 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $128.82 / $309.03
| Professional | | $43.65 | $128.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Professional | 50 | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $741.31 / $2,818.38
| Facility | | $56.23 | $741.31 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $114.82 / $338.84
| Professional | | $38.90 | $114.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $42.66 / $100.00
| Facility | | $42.66 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $141.25 / $263.03
| Professional | | $63.10 | $141.25 | $263.03 |
- 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
- $58.88 / $162.18 / $331.13
| Professional | | $58.88 | $162.18 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $83.18 / $7,079.46
| Facility | | $39.81 | $83.18 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $181.97 / $338.84
| Professional | | $147.91 | $181.97 | $338.84 |
- 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
- $40.74 / $123.03 / $316.23
| Professional | | $40.74 | $123.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $2,818.38
| Facility | | $56.23 | $758.58 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $114.82 / $338.84
| Professional | | $38.90 | $114.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,819.70 / $2,818.38
| Facility | | $575.44 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $144.54 / $331.13
| Professional | | $52.48 | $144.54 | $331.13 |