- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $131.83
| Facility | | $36.31 | $36.31 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $89.13 / $181.97
| Professional | | $33.11 | $89.13 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $588.84 / $2,818.38
| Facility | | $56.23 | $588.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $97.72 / $281.84
| Professional | | $37.15 | $97.72 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $91.20
| Facility | | $38.90 | $38.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $141.25 / $234.42
| Professional | | $51.29 | $141.25 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $97.72 / $251.19
| Professional | | $44.67 | $97.72 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $380.19 / $7,079.46
| Facility | | $38.90 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $141.25 / $204.17
| Professional | | $114.82 | $141.25 | $204.17 |
- 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
- $36.31 / $100.00 / $251.19
| Professional | | $36.31 | $100.00 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $588.84 / $2,818.38
| Facility | | $56.23 | $588.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $97.72 / $275.42
| Professional | | $37.15 | $97.72 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $100.00 / $257.04
| Professional | | $39.81 | $100.00 | $257.04 |