- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.94 / $2,011.00 / $7,602.00
| Facility | | $78.94 | $2,011.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.14 / $98.55 / $166.46
| Professional | | $27.14 | $98.55 | $166.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,483.00 / $2,244.00
| Facility | | $764.00 | $1,483.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.56 / $107.78 / $215.57
| Professional | | $32.56 | $107.78 | $215.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.97 / $105.53 / $216.31
| Professional | | $33.97 | $105.53 | $216.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $208.50 / $208.50
| Facility | | $55.00 | $208.50 | $208.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.37 / $852.84 / $952.58
| Professional | | $423.37 | $852.84 | $952.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.13 / $157.15 / $278.52
| Professional | | $110.13 | $157.15 | $278.52 |