- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.72 / $2,094.00 / $4,957.55
| Facility | | $333.72 | $2,094.00 | $4,957.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.04 / $170.72 / $590.07
| Professional | | $74.04 | $170.72 | $590.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $689.33 / $1,112.50 / $1,571.75
| Professional | 50 | $689.33 | $1,112.50 | $1,571.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.97 / $2,329.00 / $4,952.00
| Facility | | $165.97 | $2,329.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.81 / $272.89 / $673.18
| Professional | | $83.81 | $272.89 | $673.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.96 / $110.45 / $216.65
| Facility | | $84.96 | $110.45 | $216.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.41 / $198.64 / $462.99
| Professional | | $108.41 | $198.64 | $462.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.97 / $290.39 / $531.64
| Professional | | $133.97 | $290.39 | $531.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $168.26 / $6,679.00
| Facility | | $83.43 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.34 / $255.68 / $457.14
| Professional | | $202.34 | $255.68 | $457.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.20 / $214.22 / $475.59
| Professional | | $93.20 | $214.22 | $475.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.33 / $1,019.18 / $6,079.20
| Facility | | $191.33 | $1,019.18 | $6,079.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.00 / $170.13 / $292.41
| Professional | | $102.00 | $170.13 | $292.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.13 / $420.78 / $1,262.16
| Professional | | $234.13 | $420.78 | $1,262.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.27 / $293.20 / $644.91
| Professional | | $229.27 | $293.20 | $644.91 |