- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $97.72 / $1,445.44
| Facility | | $57.54 | $97.72 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $97.72 / $229.09
| Professional | | $57.54 | $97.72 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $91.20 / $371.54 / $416.87
| Professional | 50 | $91.20 | $371.54 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,318.26 / $3,162.28
| Facility | | $158.49 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,621.81 / $2,951.21 / $7,413.10
| Facility | 50 | $1,621.81 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $181.97 / $338.84
| Professional | | $107.15 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $269.15 / $467.74
| Professional | 50 | $154.88 | $269.15 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $870.96
| Facility | | $251.19 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $416.87
| Professional | | $123.03 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $346.74 / $691.83
| Facility | | $281.84 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $218.78 / $398.11
| Professional | | $125.89 | $218.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $151.36 / $1,412.54
| Facility | | $63.10 | $151.36 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $1,288.25
| Professional | | $102.33 | $213.80 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,238.72 / $5,495.41
| Facility | | $1,174.90 | $2,238.72 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $151.36 / $302.00
| Professional | | $75.86 | $151.36 | $302.00 |