- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,230.27 / $6,309.57
| Facility | | $436.52 | $1,230.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $120.23 / $389.05
| Professional | | $52.48 | $120.23 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $107.15 / $173.78
| Professional | | $60.26 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $91.20 / $158.49 / $251.19
| Professional | 50 | $91.20 | $158.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $125.89 / $263.03
| Professional | | $79.43 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $114.82 / $114.82
| Professional | | $109.65 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,023.29
| Facility | | $660.69 | $812.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $107.15 / $107.15
| Professional | | $43.65 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $100.00 / $199.53
| Professional | | $53.70 | $100.00 | $199.53 |