- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,819.70 / $3,715.35
| Facility | | $251.19 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $263.03 / $741.31
| Professional | | $125.89 | $263.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $173.78 / $524.81 / $1,318.26
| Professional | 50 | $173.78 | $524.81 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $32,359.37
| Facility | | $302.00 | $1,862.09 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $309.03 / $831.76
| Professional | | $138.04 | $309.03 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $354.81
| Facility | | $151.36 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $398.11 / $741.31
| Professional | | $213.80 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $302.00 / $660.69
| Professional | | $158.49 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $251.19 / $7,079.46
| Facility | | $117.49 | $251.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $562.34
| Professional | | $331.13 | $407.38 | $562.34 |
- 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
- $141.25 / $316.23 / $741.31
| Professional | | $141.25 | $316.23 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,548.82 / $2,818.38
| Facility | | $776.25 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $32,359.37
| Facility | | $302.00 | $1,862.09 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $309.03 / $812.83
| Professional | | $138.04 | $309.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,454.71 / $6,165.95
| Facility | | $1,047.13 | $2,454.71 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $316.23 / $724.44
| Professional | | $144.54 | $316.23 | $724.44 |