- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $2,187.76 / $3,801.89
| Facility | | $158.49 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Facility | 50 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $134.90 / $302.00
| Professional | | $77.62 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $346.74 / $1,288.25
| Professional | 50 | $199.53 | $346.74 | $1,288.25 |
- 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
- $81.28 / $162.18 / $380.19
| Professional | | $81.28 | $162.18 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $204.17
| Facility | | $87.10 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $181.97 / $338.84
| Professional | | $97.72 | $181.97 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $177.83 / $7,079.46
| Facility | | $74.13 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $213.80 / $295.12
| Professional | | $169.82 | $213.80 | $295.12 |
- 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
- $87.10 / $181.97 / $389.05
| Professional | | $87.10 | $181.97 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- 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
- $81.28 / $162.18 / $380.19
| Professional | | $81.28 | $162.18 | $380.19 |
- 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
- $89.13 / $173.78 / $371.54
| Professional | | $89.13 | $173.78 | $371.54 |