- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,949.84 / $3,715.35
| Facility | | $204.17 | $1,949.84 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $204.17 / $467.74
| Professional | | $81.28 | $204.17 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.09 / $512.86 / $1,096.48
| Professional | 50 | $229.09 | $512.86 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,862.09 / $19,498.45
| Facility | | $199.53 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $234.42 / $707.95
| Professional | | $87.10 | $234.42 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $234.42
| Facility | | $100.00 | $100.00 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $346.74 / $588.84
| Professional | | $128.82 | $346.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $213.80 / $524.81
| Professional | | $104.71 | $213.80 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $257.04 / $7,079.46
| Facility | | $79.43 | $257.04 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $354.81 / $446.68
| Professional | | $288.40 | $354.81 | $446.68 |
- 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
- $93.33 / $251.19 / $630.96
| Professional | | $93.33 | $251.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $1,659.59
| Facility | | $1,047.13 | $1,513.56 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,862.09 / $19,498.45
| Facility | | $199.53 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $234.42 / $707.95
| Professional | | $87.10 | $234.42 | $707.95 |
- 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
- $93.33 / $229.09 / $616.60
| Professional | | $93.33 | $229.09 | $616.60 |