- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.04 / $140.55 / $2,042.00
| Facility | | $99.04 | $140.55 | $2,042.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.71 / $126.57 / $200.47
| Professional | | $90.71 | $126.57 | $200.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $517.23 / $517.23 / $517.23
| Professional | 50 | $517.23 | $517.23 | $517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.01 / $504.98 / $1,052.56
| Facility | | $176.01 | $504.98 | $1,052.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $675.36 / $1,024.66 / $1,796.66
| Facility | 50 | $675.36 | $1,024.66 | $1,796.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.49 / $330.00 / $512.64
| Professional | | $195.49 | $330.00 | $512.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $290.33 / $479.22 / $745.89
| Professional | 50 | $290.33 | $479.22 | $745.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.88 / $499.27 / $1,201.07
| Facility | | $351.88 | $499.27 | $1,201.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.36 / $356.09 / $602.83
| Professional | | $214.36 | $356.09 | $602.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.89 / $456.46 / $945.73
| Facility | | $319.89 | $456.46 | $945.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.40 / $325.23 / $549.69
| Professional | | $206.40 | $325.23 | $549.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.04 / $200.47 / $389.67
| Facility | | $99.04 | $200.47 | $389.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.56 / $256.19 / $876.00
| Professional | | $134.56 | $256.19 | $876.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.00 / $1,727.00 / $2,883.00
| Facility | | $382.00 | $1,727.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.31 / $283.11 / $502.40
| Professional | | $136.31 | $283.11 | $502.40 |