- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.62 / $1,011.00 / $3,500.00
| Facility | | $122.62 | $1,011.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,222.00 / $1,222.00 / $1,222.00
| Facility | 50 | $1,222.00 | $1,222.00 | $1,222.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.38 / $158.91 / $353.54
| Professional | | $61.38 | $158.91 | $353.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.46 / $196.46 / $196.46
| Professional | | $196.46 | $196.46 | $196.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.18 / $414.65 / $959.86
| Facility | | $194.18 | $414.65 | $959.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.92 / $131.16 / $353.62
| Professional | | $85.92 | $131.16 | $353.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.05 / $111.53 / $111.53
| Facility | | $57.05 | $111.53 | $111.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.60 / $127.60 / $127.60
| Facility | | $127.60 | $127.60 | $127.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.09 / $161.56 / $367.38
| Professional | | $78.09 | $161.56 | $367.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $580.00 / $1,506.00
| Facility | | $210.00 | $580.00 | $1,506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.61 / $245.70 / $503.26
| Professional | | $177.61 | $245.70 | $503.26 |