- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.72 / $330.05 / $2,168.00
| Facility | | $62.72 | $330.05 | $2,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.72 / $147.49 / $387.08
| Professional | | $62.72 | $147.49 | $387.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.16 / $1,074.58 / $2,427.64
| Facility | | $149.16 | $1,074.58 | $2,427.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,557.64 / $2,363.28 / $4,143.79
| Facility | 50 | $1,557.64 | $2,363.28 | $4,143.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.90 / $402.68 / $1,084.42
| Professional | | $136.90 | $402.68 | $1,084.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.28 / $1,153.82 / $2,775.68
| Facility | | $739.28 | $1,153.82 | $2,775.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.80 / $273.45 / $1,198.20
| Professional | | $93.80 | $273.45 | $1,198.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.65 / $1,017.29 / $2,185.58
| Facility | | $640.65 | $1,017.29 | $2,185.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.94 / $446.96 / $1,094.31
| Professional | | $138.94 | $446.96 | $1,094.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.16 / $293.80 / $835.29
| Facility | | $84.16 | $293.80 | $835.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,656.08 / $2,656.08 / $2,656.08
| Facility | 50 | $2,656.08 | $2,656.08 | $2,656.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.54 / $520.88 / $1,182.09
| Professional | | $209.54 | $520.88 | $1,182.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.36 / $2,208.19 / $4,241.00
| Facility | | $1,609.36 | $2,208.19 | $4,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.50 / $520.88 / $995.64
| Professional | | $215.50 | $520.88 | $995.64 |