- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.50 / $2,067.00 / $3,625.00
| Facility | | $203.50 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $655.72 / $1,055.44 / $1,360.40
| Facility | 50 | $655.72 | $1,055.44 | $1,360.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.88 / $171.92 / $296.86
| Professional | | $107.88 | $171.92 | $296.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $177.50 / $213.04 / $1,032.15
| Professional | 50 | $177.50 | $213.04 | $1,032.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.86 / $1,177.70 / $3,804.00
| Facility | | $174.86 | $1,177.70 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.50 / $272.27 / $784.48
| Professional | | $119.50 | $272.27 | $784.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.99 / $160.61 / $286.73
| Facility | | $124.99 | $160.61 | $286.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.54 / $249.87 / $431.83
| Professional | | $146.54 | $249.87 | $431.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.92 / $214.32 / $6,679.00
| Facility | | $108.92 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.75 / $223.79 / $308.23
| Professional | | $184.75 | $223.79 | $308.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.21 / $294.81 / $493.76
| Professional | | $140.21 | $294.81 | $493.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.07 / $1,770.07 / $1,770.07
| Facility | | $1,770.07 | $1,770.07 | $1,770.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.82 / $258.82 / $258.82
| Professional | | $258.82 | $258.82 | $258.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,600.00 / $7,161.00
| Facility | | $55.00 | $1,600.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.97 / $350.26 / $1,310.76
| Professional | | $199.97 | $350.26 | $1,310.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.40 / $290.22 / $481.03
| Professional | | $186.40 | $290.22 | $481.03 |