- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,230.27 / $3,388.44
| Facility | | $181.97 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $204.17 / $676.08
| Professional | | $67.61 | $204.17 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.09 / $616.60 / $1,148.15
| Professional | 50 | $229.09 | $616.60 | $1,148.15 |
- 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
- $72.44 / $229.09 / $1,023.29
| Professional | | $72.44 | $229.09 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $181.97
| Facility | | $77.62 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $199.53 / $602.56
| Professional | | $77.62 | $199.53 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $194.98 / $537.03
| Professional | | $77.62 | $194.98 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $177.83 / $7,079.46
| Facility | | $58.88 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $549.54
| Professional | | $275.42 | $363.08 | $549.54 |
- 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
- $69.18 / $234.42 / $588.84
| Professional | | $69.18 | $234.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $363.08 / $1,548.82
| Facility | | $154.88 | $363.08 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $107.15 / $218.78
| Professional | | $104.71 | $107.15 | $218.78 |
- 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
- $72.44 / $223.87 / $1,023.29
| Professional | | $72.44 | $223.87 | $1,023.29 |
- 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
- $77.62 / $223.87 / $616.60
| Professional | | $77.62 | $223.87 | $616.60 |