- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $398.11 / $5,128.61
| Facility | | $67.61 | $398.11 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $79.43 / $177.83
| Professional | | $52.48 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $107.15 / $107.15 / $371.54
| Professional | 50 | $107.15 | $107.15 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $363.08 / $2,951.21
| Facility | | $56.23 | $363.08 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $87.10 / $208.93
| Professional | | $51.29 | $87.10 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $131.83
| Facility | | $57.54 | $57.54 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $100.00 / $151.36
| Professional | | $57.54 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $117.49 / $117.49
| Professional | 50 | $109.65 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $104.71 / $190.55
| Professional | | $60.26 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $177.83 / $7,079.46
| Facility | | $51.29 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $93.33 / $131.83
| Professional | | $70.79 | $93.33 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $3,467.37
| Facility | | $501.19 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $83.18 / $173.78
| Professional | | $50.12 | $83.18 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $223.87 / $588.84
| Facility | | $70.79 | $223.87 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $95.50 / $125.89
| Professional | | $57.54 | $95.50 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $363.08 / $2,951.21
| Facility | | $56.23 | $363.08 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $87.10 / $208.93
| Professional | | $51.29 | $87.10 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,819.70 / $2,818.38
| Facility | | $338.84 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $89.13 / $177.83
| Professional | | $54.95 | $89.13 | $177.83 |