- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $1,000.00 / $3,890.45
| Facility | | $60.26 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $112.20 / $173.78
| Professional | | $46.77 | $112.20 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,715.19 / $11,220.18
| Facility | | $9,549.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $97.72 / $371.54
| Professional | | $47.86 | $97.72 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $63.10 / $81.28
| Facility | | $45.71 | $63.10 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $63.10 / $74.13
| Professional | | $46.77 | $63.10 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $85.11 / $123.03
| Facility | | $34.67 | $85.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $144.54 / $3,548.13
| Professional | | $52.48 | $144.54 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $33.11 / $38.02
| Professional | | $28.84 | $33.11 | $38.02 |
- 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
- $50.12 / $104.71 / $269.15
| Professional | | $50.12 | $104.71 | $269.15 |