- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $316.23 / $316.23
| Facility | | $123.03 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $245.47 / $501.19
| Professional | | $107.15 | $245.47 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $2,137.96
| Facility | | $467.74 | $741.31 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $416.87 / $851.14
| Professional | | $199.53 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $602.56 / $1,230.27
| Professional | 50 | $295.12 | $602.56 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $2,570.40
| Facility | | $758.58 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $1,202.26
| Professional | | $251.19 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $2,041.74
| Facility | | $831.76 | $1,023.29 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $489.78 / $1,047.13
| Professional | | $257.04 | $489.78 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $316.23 / $776.25
| Facility | | $128.82 | $316.23 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $1,202.26
| Professional | | $269.15 | $512.86 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Professional | 50 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,862.09 / $3,715.35
| Facility | | $812.83 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $354.81 / $812.83
| Professional | | $151.36 | $354.81 | $812.83 |