- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.00 / $2,209.06 / $3,693.00
| Facility | | $467.00 | $2,209.06 | $3,693.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $305.49 / $583.75 / $2,279.50
| Facility | 50 | $305.49 | $583.75 | $2,279.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.47 / $156.43 / $288.52
| Professional | | $123.47 | $156.43 | $288.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.63 / $331.98 / $2,372.73
| Professional | 50 | $87.63 | $331.98 | $2,372.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.47 / $2,948.45 / $12,379.00
| Facility | | $385.47 | $2,948.45 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.42 / $307.42 / $2,496.46
| Professional | | $169.42 | $307.42 | $2,496.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.18 / $303.18 / $303.18
| Professional | | $303.18 | $303.18 | $303.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.37 / $326.44 / $591.63
| Professional | | $223.37 | $326.44 | $591.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.47 / $337.10 / $6,679.00
| Facility | | $160.47 | $337.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.54 / $227.54 / $407.88
| Professional | | $180.54 | $227.54 | $407.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.20 / $391.30 / $521.50
| Professional | | $196.20 | $391.30 | $521.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.97 / $434.97 / $548.95
| Facility | | $434.97 | $434.97 | $548.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.29 / $236.29 / $236.29
| Professional | | $236.29 | $236.29 | $236.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $337.56 / $337.56 / $337.56
| Professional | 50 | $337.56 | $337.56 | $337.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,525.00 / $16,394.00
| Facility | | $1,061.00 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.39 / $337.10 / $2,496.46
| Professional | | $198.39 | $337.10 | $2,496.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.74 / $253.19 / $534.63
| Professional | | $195.74 | $253.19 | $534.63 |