- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.15 / $314.35 / $2,168.00
| Facility | | $124.15 | $314.35 | $2,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.73 / $240.00 / $496.60
| Professional | | $110.73 | $240.00 | $496.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.60 / $660.68 / $1,178.08
| Facility | | $378.60 | $660.68 | $1,178.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.55 / $422.54 / $882.77
| Professional | | $207.55 | $422.54 | $882.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $299.83 / $610.61 / $1,239.11
| Professional | 50 | $299.83 | $610.61 | $1,239.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.45 / $1,023.63 / $2,462.48
| Facility | | $721.45 | $1,023.63 | $2,462.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.89 / $500.65 / $1,149.88
| Professional | | $248.89 | $500.65 | $1,149.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.36 / $935.84 / $1,938.96
| Facility | | $568.36 | $935.84 | $1,938.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.91 / $469.63 / $959.77
| Professional | | $227.91 | $469.63 | $959.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.54 / $318.54 / $813.13
| Facility | | $128.54 | $318.54 | $813.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.41 / $528.79 / $1,149.69
| Professional | | $299.41 | $528.79 | $1,149.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,330.66 / $2,330.66 / $2,330.66
| Professional | 50 | $2,330.66 | $2,330.66 | $2,330.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.52 / $489.94 / $1,043.28
| Professional | | $305.52 | $489.94 | $1,043.28 |