- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.25 / $2,260.42 / $4,346.00
| Facility | | $230.25 | $2,260.42 | $4,346.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $934.24 / $2,419.17 / $3,805.50
| Facility | 50 | $934.24 | $2,419.17 | $3,805.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.18 / $197.91 / $620.62
| Professional | | $139.18 | $197.91 | $620.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $229.65 / $621.95 / $1,468.29
| Professional | 50 | $229.65 | $621.95 | $1,468.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.32 / $2,411.51 / $10,821.00
| Facility | | $398.32 | $2,411.51 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.18 / $306.74 / $1,444.89
| Professional | | $159.18 | $306.74 | $1,444.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.52 / $314.52 / $314.52
| Professional | | $314.52 | $314.52 | $314.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.92 / $339.76 / $615.79
| Professional | | $207.92 | $339.76 | $615.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.32 / $349.74 / $6,679.00
| Facility | | $164.32 | $349.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.86 / $233.60 / $417.65
| Professional | | $184.86 | $233.60 | $417.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.66 / $396.21 / $528.04
| Professional | | $198.66 | $396.21 | $528.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.47 / $2,273.15 / $4,580.52
| Facility | | $668.47 | $2,273.15 | $4,580.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.95 / $509.90 / $764.85
| Professional | | $254.95 | $509.90 | $764.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.52 / $351.57 / $369.15
| Professional | 50 | $208.52 | $351.57 | $369.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,672.00 / $26,542.00
| Facility | | $822.00 | $3,672.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.37 / $349.74 / $1,444.89
| Professional | | $181.37 | $349.74 | $1,444.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.27 / $244.82 / $544.74
| Professional | | $179.27 | $244.82 | $544.74 |