- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $2,089.30 / $3,715.35
| Facility | | $158.49 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $100.00 / $257.04
| Professional | | $54.95 | $100.00 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $60.26 / $218.78 / $354.81
| Professional | 50 | $60.26 | $218.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,174.90 / $3,801.89
| Facility | | $56.23 | $1,174.90 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $112.20 / $288.40
| Professional | | $58.88 | $112.20 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $144.54
| Facility | | $63.10 | $63.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $239.88
| Professional | | $89.13 | $144.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $128.82 / $245.47
| Professional | | $69.18 | $128.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $102.33 / $7,079.46
| Facility | | $56.23 | $102.33 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $181.97
| Professional | | $102.33 | $128.82 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $109.65 / $234.42
| Professional | | $57.54 | $109.65 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $630.96
| Facility | | $281.84 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,174.90 / $3,801.89
| Facility | | $56.23 | $1,174.90 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $112.20 / $288.40
| Professional | | $58.88 | $112.20 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $6,165.95
| Facility | | $954.99 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $117.49 / $245.47
| Professional | | $63.10 | $117.49 | $245.47 |