- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,548.82 / $5,623.41
| Facility | | $245.47 | $1,548.82 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $467.74
| Professional | | $134.90 | $223.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | 50 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $2,818.38
| Facility | | $1,230.27 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $371.54
| Professional | | $151.36 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $426.58
| Professional | | $144.54 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $323.59 / $741.31
| Professional | | $158.49 | $323.59 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $162.18 / $281.84
| Professional | | $158.49 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,238.72 / $4,570.88
| Facility | | $812.83 | $2,238.72 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $389.05
| Professional | | $141.25 | $223.87 | $389.05 |