- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.31 / $105.07 / $105.07
| Facility | | $85.31 | $105.07 | $105.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.07 / $105.07 / $168.47
| Professional | | $85.07 | $105.07 | $168.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $145.08 / $145.08 / $180.38
| Professional | 50 | $145.08 | $145.08 | $180.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.82 / $1,099.21 / $2,307.86
| Facility | | $517.82 | $1,099.21 | $2,307.86 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $908.51 / $1,378.41 / $2,416.92
| Facility | 50 | $908.51 | $1,378.41 | $2,416.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.18 / $193.99 / $330.96
| Professional | | $133.18 | $193.99 | $330.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $193.55 / $278.95 / $455.46
| Professional | 50 | $193.55 | $278.95 | $455.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.97 / $347.58 / $836.15
| Facility | | $244.97 | $347.58 | $836.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.87 / $237.36 / $411.48
| Professional | | $143.87 | $237.36 | $411.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.25 / $317.77 / $658.39
| Facility | | $199.25 | $317.77 | $658.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.88 / $222.82 / $386.76
| Professional | | $140.88 | $222.82 | $386.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.84 / $158.32 / $563.00
| Facility | | $80.84 | $158.32 | $563.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $525.50 / $525.50 / $525.50
| Facility | 50 | $525.50 | $525.50 | $525.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.21 / $172.49 / $595.60
| Professional | | $103.21 | $172.49 | $595.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $307.29 / $314.32 / $484.73
| Professional | 50 | $307.29 | $314.32 | $484.73 |
- 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
- $103.21 / $165.54 / $342.48
| Professional | | $103.21 | $165.54 | $342.48 |