- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.88 / $193.84 / $2,168.00
| Facility | | $118.88 | $193.84 | $2,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.81 / $146.50 / $309.49
| Professional | | $95.81 | $146.50 | $309.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.08 / $3,665.85 / $8,281.67
| Facility | | $515.08 | $3,665.85 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,313.75 / $8,062.11 / $14,136.20
| Facility | 50 | $5,313.75 | $8,062.11 | $14,136.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.26 / $315.97 / $592.89
| Professional | | $194.26 | $315.97 | $592.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $282.63 / $466.68 / $814.76
| Professional | 50 | $282.63 | $466.68 | $814.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.38 / $639.02 / $1,537.26
| Facility | | $450.38 | $639.02 | $1,537.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.04 / $387.23 / $758.21
| Professional | | $218.04 | $387.23 | $758.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.31 / $584.22 / $1,210.44
| Facility | | $366.31 | $584.22 | $1,210.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.66 / $379.76 / $712.66
| Professional | | $215.66 | $379.76 | $712.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.35 / $230.76 / $543.82
| Facility | | $117.35 | $230.76 | $543.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.89 / $319.35 / $830.56
| Professional | | $184.89 | $319.35 | $830.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $308.14 / $308.14 / $308.14
| Professional | 50 | $308.14 | $308.14 | $308.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.49 / $302.05 / $646.78
| Professional | | $190.49 | $302.05 | $646.78 |