- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $112.20 / $2,691.53
| Facility | | $52.48 | $112.20 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $104.71 / $223.87
| Professional | | $52.48 | $104.71 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1,548.82 / $2,454.71
| Facility | | $1.00 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $181.97 / $363.08
| Professional | | $93.33 | $181.97 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $1,000.00
| Facility | | $263.03 | $416.87 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $467.74
| Professional | | $112.20 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $398.11 / $776.25
| Facility | | $323.59 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $204.17 / $407.38
| Professional | | $112.20 | $204.17 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $141.25 / $562.34
| Facility | | $60.26 | $141.25 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $229.09 / $537.03
| Professional | | $112.20 | $229.09 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,862.09 / $3,467.37
| Facility | | $380.19 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $147.91 / $323.59
| Professional | | $72.44 | $147.91 | $323.59 |