- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $257.04
| Facility | | $158.49 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $588.84
| Professional | | $138.04 | $223.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $4,466.84 / $10,715.19
| Facility | | $346.74 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,495.41 / $9,772.37 / $25,118.86
| Facility | 50 | $5,495.41 | $9,772.37 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $758.58
| Professional | | $251.19 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $380.19 / $616.60 / $1,071.52
| Professional | 50 | $380.19 | $616.60 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $2,137.96
| Facility | | $630.96 | $891.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $562.34 / $1,000.00
| Professional | | $309.03 | $562.34 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,659.59
| Facility | | $691.83 | $851.14 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $954.99
| Professional | | $331.13 | $549.54 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $309.03 / $691.83
| Facility | | $173.78 | $309.03 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $426.58 / $1,096.48
| Professional | | $234.42 | $426.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $8,912.51
| Facility | | $1,584.89 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $707.95
| Professional | | $190.55 | $338.84 | $707.95 |