- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $5,011.87
| Facility | | $151.36 | $151.36 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $257.04
| Professional | | $131.83 | $151.36 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $6,165.95 / $14,791.08
| Facility | | $870.96 | $6,165.95 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,585.78 / $13,803.84 / $34,673.69
| Facility | 50 | $7,585.78 | $13,803.84 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $346.74 / $549.54
| Professional | | $229.09 | $346.74 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $1,348.96
| Facility | | $398.11 | $562.34 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $724.44
| Professional | | $316.23 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $1,047.13
| Facility | | $436.52 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $407.38 / $602.56
| Professional | | $288.40 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $316.23 / $6,025.60
| Facility | | $194.98 | $316.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 50 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $851.14
| Professional | | $177.83 | $302.00 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,548.13 / $8,317.64
| Facility | | $1,584.89 | $3,548.13 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $588.84
| Professional | | $173.78 | $302.00 | $588.84 |