- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.48 / $468.00 / $4,500.00
| Facility | | $242.48 | $468.00 | $4,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.23 / $156.28 / $317.42
| Professional | | $51.23 | $156.28 | $317.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.16 / $162.44 / $301.75
| Professional | | $106.16 | $162.44 | $301.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.93 / $207.85 / $412.94
| Facility | | $101.93 | $207.85 | $412.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.63 / $185.02 / $309.76
| Professional | | $152.63 | $185.02 | $309.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $310.58
| Professional | | $32.34 | $32.34 | $310.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.20 / $2,276.55 / $3,067.56
| Facility | | $1,648.20 | $2,276.55 | $3,067.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,355.77 / $3,414.83 / $4,783.64
| Facility | 50 | $2,355.77 | $3,414.83 | $4,783.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.00 / $294.68 / $362.58
| Professional | | $154.00 | $294.68 | $362.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $3,450.00 / $7,609.00
| Facility | | $500.00 | $3,450.00 | $7,609.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.36 / $230.46 / $336.80
| Professional | | $180.36 | $230.46 | $336.80 |