- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $389.05 / $6,918.31
| Facility | | $162.18 | $389.05 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $363.08
| Professional | | $107.15 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $263.03 / $549.54
| Professional | 50 | $72.44 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | 50 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $208.93 / $457.09
| Professional | | $114.82 | $208.93 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $389.05
| Professional | | $123.03 | $218.78 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $309.03
| Facility | | $107.15 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $158.49 / $389.05
| Professional | | $5.01 | $158.49 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $758.58 / $1,949.84
| Facility | | $177.83 | $758.58 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $338.84
| Professional | | $102.33 | $173.78 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,548.82 / $1,548.82
| Facility | | $56.23 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,548.82
| Professional | | $1,318.26 | $1,318.26 | $1,548.82 |