- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $891.25 / $3,235.94
| Facility | | $123.03 | $891.25 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $141.25 / $436.52
| Professional | | $48.98 | $141.25 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $125.89 / $562.34 / $724.44
| Professional | 50 | $125.89 | $562.34 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $2,951.21
| Facility | | $56.23 | $954.99 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $162.18 / $707.95
| Professional | | $52.48 | $162.18 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $131.83
| Facility | | $56.23 | $56.23 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $147.91 / $426.58
| Professional | | $56.23 | $147.91 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $177.83 / $398.11
| Professional | | $63.10 | $177.83 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $89.13 / $7,079.46
| Facility | | $51.29 | $89.13 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $245.47 / $398.11
| Professional | | $190.55 | $245.47 | $398.11 |
- 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
- $51.29 / $162.18 / $398.11
| Professional | | $51.29 | $162.18 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $316.23 / $758.58
| Facility | | $114.82 | $316.23 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $91.20 / $398.11
| Professional | | $69.18 | $91.20 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,000.00 / $2,951.21
| Facility | | $56.23 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $158.49 / $707.95
| Professional | | $52.48 | $158.49 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,818.38
| Facility | | $501.19 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $158.49 / $398.11
| Professional | | $56.23 | $158.49 | $398.11 |