- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $6,025.60 / $16,595.87
| Facility | | $346.74 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $263.03 / $457.09
| Professional | | $144.54 | $263.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,818.38
| Professional | 50 | $1,479.11 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Professional | 50 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,168.69 / $7,762.47
| Facility | | $1,995.26 | $4,168.69 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $288.40 / $371.54
| Professional | | $131.83 | $288.40 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $309.03 / $524.81
| Professional | | $186.21 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $295.12 / $575.44
| Facility | | $158.49 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,000.00
| Facility | | $1,698.24 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $457.09
| Professional | | $144.54 | $257.04 | $457.09 |