- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $2,640.00 / $5,506.00
| Facility | | $1,050.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.83 / $177.30 / $746.00
| Professional | | $89.83 | $177.30 | $746.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $330.11 / $1,119.00 / $1,279.50
| Professional | 50 | $330.11 | $1,119.00 | $1,279.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.39 / $187.10 / $243.23
| Professional | | $168.39 | $187.10 | $243.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $224.52 / $280.64 / $364.85
| Professional | 50 | $224.52 | $280.64 | $364.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.59 / $175.04 / $286.30
| Facility | | $47.59 | $175.04 | $286.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.23 / $147.57 / $208.85
| Professional | | $92.23 | $147.57 | $208.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.70 / $246.70 / $246.70
| Facility | | $246.70 | $246.70 | $246.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.10 / $165.20 / $279.25
| Professional | | $84.10 | $165.20 | $279.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.67 / $205.81 / $1,448.00
| Facility | | $81.67 | $205.81 | $1,448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.11 / $207.86 / $1,466.96
| Professional | | $162.11 | $207.86 | $1,466.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $649.35 / $649.35 / $649.35
| Professional | 50 | $649.35 | $649.35 | $649.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.50 / $194.61 / $313.75
| Professional | | $157.50 | $194.61 | $313.75 |