- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,090.30 / $6,309.57
| Facility | | $1,348.96 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $81.28 / $371.54
| Professional | | $23.99 | $81.28 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Professional | 50 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,230.27 / $1,819.70
| Facility | | $380.19 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $23.99 / $46.77
| Professional | | $17.38 | $23.99 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $100.00 / $309.03
| Professional | | $27.54 | $100.00 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $45.71 / $1,862.09
| Facility | | $23.44 | $45.71 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $181.97 / $1,949.84
| Professional | | $33.11 | $181.97 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,513.56 / $3,235.94
| Facility | | $758.58 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $81.28 / $239.88
| Professional | | $26.30 | $81.28 | $239.88 |