- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.13 / $151.13 / $7,975.90
| Facility | | $151.13 | $151.13 | $7,975.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.33 / $151.13 / $248.28
| Professional | | $129.33 | $151.13 | $248.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.86 / $5,064.68 / $11,441.84
| Facility | | $687.86 | $5,064.68 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,341.39 / $11,138.50 / $19,530.37
| Facility | 50 | $7,341.39 | $11,138.50 | $19,530.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.83 / $398.34 / $558.91
| Professional | | $256.83 | $398.34 | $558.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.33 / $535.11 / $1,287.27
| Facility | | $377.33 | $535.11 | $1,287.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.55 / $515.91 / $730.66
| Professional | | $304.55 | $515.91 | $730.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.75 / $489.22 / $1,013.60
| Facility | | $306.75 | $489.22 | $1,013.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.13 / $458.85 / $608.07
| Professional | | $268.13 | $458.85 | $608.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.50 / $311.49 / $5,920.00
| Facility | | $208.50 | $311.49 | $5,920.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $989.33 / $989.33 / $989.33
| Facility | 50 | $989.33 | $989.33 | $989.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.15 / $383.39 / $858.76
| Professional | | $200.15 | $383.39 | $858.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,523.00 / $6,275.00 / $10,729.12
| Facility | | $2,523.00 | $6,275.00 | $10,729.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.62 / $422.95 / $591.14
| Professional | | $207.62 | $422.95 | $591.14 |