- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $2,238.72 / $3,801.89
| Facility | | $75.86 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $74.13 / $190.55
| Professional | | $40.74 | $74.13 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,023.29 / $13,489.63
| Facility | | $100.00 | $1,023.29 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $89.13 / $229.09
| Professional | | $43.65 | $89.13 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $112.20
| Facility | | $47.86 | $47.86 | $112.20 |
- 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
- $56.23 / $107.15 / $239.88
| Professional | | $56.23 | $107.15 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $177.83 / $7,079.46
| Facility | | $46.77 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $93.33 / $138.04
| Professional | | $50.12 | $93.33 | $138.04 |
- 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
- $45.71 / $95.50 / $204.17
| Professional | | $45.71 | $95.50 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,071.52 / $13,489.63
| Facility | | $100.00 | $1,071.52 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $89.13 / $223.87
| Professional | | $43.65 | $89.13 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,819.70 / $2,818.38
| Facility | | $323.59 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $95.50 / $204.17
| Professional | | $46.77 | $95.50 | $204.17 |