- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,905.46 / $3,630.78
| Facility | | $181.97 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $138.04 / $309.03
| Facility | 50 | $138.04 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $102.33 / $316.23
| Professional | | $56.23 | $102.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $302.00 / $575.44
| Professional | 50 | $109.65 | $302.00 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $602.56 / $2,951.21
| Facility | | $56.23 | $602.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $257.04
| Professional | | $61.66 | $100.00 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $151.36
| Facility | | $66.07 | $66.07 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $114.82 / $190.55
| Professional | | $66.07 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $114.82 / $199.53
| Professional | | $61.66 | $114.82 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $104.71 / $7,079.46
| Facility | | $56.23 | $104.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $162.18
| Professional | | $100.00 | $125.89 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $109.65 / $229.09
| Professional | | $60.26 | $109.65 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $426.58 / $660.69
| Facility | | $204.17 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $162.18 / $190.55
| Professional | | $117.49 | $162.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $602.56 / $2,951.21
| Facility | | $56.23 | $602.56 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $251.19
| Professional | | $61.66 | $100.00 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $107.15 / $223.87
| Professional | | $61.66 | $107.15 | $223.87 |