- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.60 / $2,663.12 / $3,625.00
| Facility | | $43.60 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.78 / $35.92 / $65.98
| Professional | | $23.78 | $35.92 | $65.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $586.61 / $2,713.00
| Facility | | $55.00 | $586.61 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.40 / $60.63 / $218.93
| Professional | | $26.40 | $60.63 | $218.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.83 / $35.76 / $63.84
| Facility | | $27.83 | $35.76 | $63.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $50.54 / $87.73
| Professional | | $32.61 | $50.54 | $87.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.73 / $168.26 / $6,679.00
| Facility | | $28.73 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.54 / $44.26 / $60.32
| Professional | | $36.54 | $44.26 | $60.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.65 / $65.09 / $97.93
| Professional | | $30.65 | $65.09 | $97.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.12 / $345.12 / $345.12
| Facility | | $345.12 | $345.12 | $345.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.82 / $47.00 / $70.27
| Professional | | $45.82 | $47.00 | $70.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.53 / $70.58 / $824.00
| Professional | | $39.53 | $70.58 | $824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.43 / $60.11 / $129.30
| Professional | | $36.43 | $60.11 | $129.30 |