- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $112.20 / $213.80
| Professional | | $47.86 | $112.20 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $676.08
| Facility | | $416.87 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $630.96 / $741.31 / $1,000.00
| Facility | 50 | $630.96 | $741.31 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $109.65 / $186.21
| Professional | | $35.48 | $109.65 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $199.53
| Facility | | $95.50 | $95.50 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $114.82 / $309.03
| Professional | | $52.48 | $114.82 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $93.33 / $234.42
| Professional | | $43.65 | $93.33 | $234.42 |