- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.73 / $1,803.00 / $3,363.00
| Facility | | $100.73 | $1,803.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.57 / $94.17 / $173.18
| Professional | | $58.57 | $94.17 | $173.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $139.16 / $156.68 / $331.80
| Professional | 50 | $139.16 | $156.68 | $331.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.51 / $627.00 / $2,733.00
| Facility | | $66.51 | $627.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.80 / $155.03 / $575.00
| Professional | | $71.80 | $155.03 | $575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.34 / $87.83 / $156.79
| Facility | | $68.34 | $87.83 | $156.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.75 / $167.41 / $379.95
| Professional | | $92.75 | $167.41 | $379.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.14 / $139.27 / $254.72
| Professional | | $80.14 | $139.27 | $254.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.40 / $212.31 / $6,679.00
| Facility | | $67.40 | $212.31 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.92 / $135.57 / $186.68
| Professional | | $111.92 | $135.57 | $186.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.15 / $161.82 / $274.83
| Professional | | $75.15 | $161.82 | $274.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.34 / $1,284.34 / $1,592.09
| Facility | | $1,284.34 | $1,284.34 | $1,592.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.00 / $152.00 / $152.00
| Professional | | $152.00 | $152.00 | $152.00 |
- 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
- $117.45 / $216.80 / $2,500.00
| Professional | | $117.45 | $216.80 | $2,500.00 |
- 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
- $106.98 / $173.42 / $301.02
| Professional | | $106.98 | $173.42 | $301.02 |