- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,819.70 / $3,715.35
| Facility | | $100.00 | $1,819.70 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $97.72 / $302.00
| Professional | | $58.88 | $97.72 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $128.82 / $338.84 / $549.54
| Professional | 50 | $128.82 | $338.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $117.49 / $281.84
| Professional | | $64.57 | $117.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $154.88
| Facility | | $67.61 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $151.36 / $263.03
| Professional | | $91.20 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $131.83 / $239.88
| Professional | | $74.13 | $131.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $109.65 / $7,079.46
| Facility | | $56.23 | $109.65 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $147.91 / $199.53
| Professional | | $117.49 | $147.91 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $123.03 / $263.03
| Professional | | $61.66 | $123.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $1,584.89
| Facility | | $1,288.25 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $630.96 / $2,818.38
| Facility | | $56.23 | $630.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $117.49 / $281.84
| Professional | | $64.57 | $117.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $123.03 / $263.03
| Professional | | $67.61 | $123.03 | $263.03 |