- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.94 / $722.12 / $5,519.00
| Facility | | $346.94 | $722.12 | $5,519.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.72 / $238.51 / $606.83
| Professional | | $148.72 | $238.51 | $606.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,212.03 / $1,212.03 / $1,212.03
| Professional | 50 | $1,212.03 | $1,212.03 | $1,212.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.25 / $204.25 / $204.83
| Facility | | $204.25 | $204.25 | $204.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.31 / $211.51 / $431.98
| Professional | | $146.31 | $211.51 | $431.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.31 / $306.58 / $637.16
| Facility | | $118.31 | $306.58 | $637.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.20 / $397.62 / $481.96
| Professional | | $193.20 | $397.62 | $481.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $343.59 / $432.26
| Professional | | $32.34 | $343.59 | $432.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.57 / $2,281.73 / $2,842.02
| Facility | | $1,595.57 | $2,281.73 | $2,842.02 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,368.01 / $3,422.61 / $4,306.64
| Facility | 50 | $2,368.01 | $3,422.61 | $4,306.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.68 / $279.92 / $508.16
| Professional | | $201.68 | $279.92 | $508.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $2,620.00 / $4,441.00
| Facility | | $450.00 | $2,620.00 | $4,441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.54 / $331.35 / $472.35
| Professional | | $203.54 | $331.35 | $472.35 |