- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.27 / $251.24 / $2,571.80
| Facility | | $116.27 | $251.24 | $2,571.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.27 / $207.71 / $352.34
| Professional | | $116.27 | $207.71 | $352.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.58 / $2,102.21 / $4,012.48
| Facility | | $1,184.58 | $2,102.21 | $4,012.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,078.36 / $3,153.33 / $5,529.09
| Facility | 50 | $2,078.36 | $3,153.33 | $5,529.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.10 / $422.80 / $848.88
| Professional | | $231.10 | $422.80 | $848.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $329.33 / $626.42 / $1,273.32
| Professional | 50 | $329.33 | $626.42 | $1,273.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.32 / $888.66 / $2,137.79
| Facility | | $626.32 | $888.66 | $2,137.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.42 / $512.99 / $1,020.14
| Professional | | $253.42 | $512.99 | $1,020.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.42 / $812.45 / $1,683.30
| Facility | | $509.42 | $812.45 | $1,683.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.35 / $474.66 / $865.89
| Professional | | $255.35 | $474.66 | $865.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.60 / $331.68 / $831.16
| Facility | | $162.60 | $331.68 | $831.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $684.50 / $1,848.69 / $2,510.69
| Facility | 50 | $684.50 | $1,848.69 | $2,510.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.42 / $446.00 / $1,831.00
| Professional | | $200.42 | $446.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.42 / $374.01 / $953.69
| Professional | | $200.42 | $374.01 | $953.69 |