- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $2,089.30 / $3,715.35
| Facility | | $87.10 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $100.00 / $257.04
| Professional | | $43.65 | $100.00 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $3,801.89
| Facility | | $56.23 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $123.03 / $302.00
| Professional | | $51.29 | $123.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $128.82
| Facility | | $54.95 | $54.95 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $251.19
| Professional | | $109.65 | $109.65 | $251.19 |
- 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
- $70.79 / $147.91 / $354.81
| Professional | | $70.79 | $147.91 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $177.83 / $7,079.46
| Facility | | $50.12 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $154.88 / $245.47
| Professional | | $123.03 | $154.88 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $117.49 / $269.15
| Professional | | $50.12 | $117.49 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $3,801.89
| Facility | | $56.23 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $123.03 / $302.00
| Professional | | $51.29 | $123.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $6,165.95
| Facility | | $954.99 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $125.89 / $275.42
| Professional | | $57.54 | $125.89 | $275.42 |