- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.26 / $130.25 / $2,042.00
| Facility | | $100.26 | $130.25 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,353.00 / $2,469.52 / $3,043.59
| Facility | 50 | $2,353.00 | $2,469.52 | $3,043.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.82 / $123.51 / $188.65
| Professional | | $97.82 | $123.51 | $188.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.54 / $783.00 / $1,241.18
| Professional | 50 | $162.54 | $783.00 | $1,241.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.92 / $924.02 / $1,988.84
| Facility | | $384.92 | $924.02 | $1,988.84 |
- 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
- $205.93 / $337.95 / $491.53
| Professional | | $205.93 | $337.95 | $491.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $301.20 / $480.23 / $715.17
| Professional | 50 | $301.20 | $480.23 | $715.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.63 / $463.44 / $1,114.86
| Facility | | $326.63 | $463.44 | $1,114.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.24 / $343.17 / $558.23
| Professional | | $210.24 | $343.17 | $558.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.94 / $423.70 / $877.85
| Facility | | $296.94 | $423.70 | $877.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.97 / $314.17 / $509.02
| Professional | | $194.97 | $314.17 | $509.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.06 / $220.12 / $504.08
| Facility | | $126.06 | $220.12 | $504.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $110.51 / $885.75 / $1,072.97
| Facility | 50 | $110.51 | $885.75 | $1,072.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.53 / $263.95 / $784.00
| Professional | | $143.53 | $263.95 | $784.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $286.62 / $286.62 / $286.62
| Professional | 50 | $286.62 | $286.62 | $286.62 |
- 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
- $143.65 / $241.28 / $512.49
| Professional | | $143.65 | $241.28 | $512.49 |