- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.03 / $159.22 / $2,168.00
| Facility | | $126.03 | $159.22 | $2,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.17 / $155.86 / $317.54
| Professional | | $115.17 | $155.86 | $317.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $58.32 / $233.79 / $933.38
| Professional | 50 | $58.32 | $233.79 | $933.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.60 / $938.85 / $2,042.46
| Facility | | $378.60 | $938.85 | $2,042.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $664.26 / $1,007.83 / $1,767.15
| Facility | 50 | $664.26 | $1,007.83 | $1,767.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.91 / $285.06 / $499.30
| Professional | | $195.91 | $285.06 | $499.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $291.36 / $414.95 / $687.51
| Professional | 50 | $291.36 | $414.95 | $687.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.88 / $521.97 / $1,255.66
| Facility | | $367.88 | $521.97 | $1,255.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.58 / $362.21 / $620.10
| Professional | | $216.58 | $362.21 | $620.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.20 / $477.20 / $988.71
| Facility | | $299.20 | $477.20 | $988.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.88 / $335.79 / $582.84
| Professional | | $208.88 | $335.79 | $582.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.44 / $237.15 / $891.68
| Facility | | $139.44 | $237.15 | $891.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,200.34 / $2,788.14 / $3,964.50
| Facility | 50 | $1,200.34 | $2,788.14 | $3,964.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.97 / $288.00 / $830.60
| Professional | | $163.97 | $288.00 | $830.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $359.07 / $718.44 / $1,189.01
| Professional | 50 | $359.07 | $718.44 | $1,189.01 |
- 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
- $170.50 / $288.00 / $568.16
| Professional | | $170.50 | $288.00 | $568.16 |