- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.38 / $2,083.00 / $3,625.00
| Facility | | $80.38 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.67 / $87.28 / $181.95
| Professional | | $69.67 | $87.28 | $181.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.56 / $1,798.55 / $4,689.00
| Facility | | $154.56 | $1,798.55 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.76 / $116.45 / $505.68
| Professional | | $62.76 | $116.45 | $505.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.21 / $106.71 / $188.59
| Facility | | $82.21 | $106.71 | $188.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.26 / $150.72 / $218.46
| Professional | | $115.26 | $150.72 | $218.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $879.33 / $879.33 / $879.33
| Professional | 50 | $879.33 | $879.33 | $879.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.40 / $62.40 / $62.40
| Facility | | $62.40 | $62.40 | $62.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.34 / $138.26 / $257.02
| Professional | | $71.34 | $138.26 | $257.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.37 / $168.26 / $6,679.00
| Facility | | $82.37 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.90 / $114.32 / $157.80
| Professional | | $90.90 | $114.32 | $157.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.79 / $176.09 / $266.73
| Professional | | $84.79 | $176.09 | $266.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.72 / $116.17 / $119.24
| Professional | | $93.72 | $116.17 | $119.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.38 / $130.91 / $596.32
| Professional | | $85.38 | $130.91 | $596.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.22 / $113.38 / $253.63
| Professional | | $81.22 | $113.38 | $253.63 |