- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,495.41 / $9,772.37
| Facility | | $645.65 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $154.88 / $371.54
| Professional | | $67.61 | $154.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $245.47 / $724.44 / $1,584.89
| Professional | 50 | $245.47 | $724.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $169.82
| Professional | | $60.26 | $100.00 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,174.90 / $1,412.54
| Facility | | $34.67 | $1,174.90 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $162.18 / $331.13
| Professional | | $77.62 | $162.18 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,317.64 / $16,595.87
| Facility | | $4,265.80 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $128.82 / $177.83
| Professional | | $120.23 | $128.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $61.66 / $218.78
| Professional | | $32.36 | $61.66 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,548.13 / $6,760.83
| Facility | | $933.25 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $144.54 / $281.84
| Professional | | $72.44 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $134.90 / $173.78
| Professional | | $56.23 | $134.90 | $173.78 |