- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.50 / $3,584.35 / $12,036.14
| Facility | | $1,011.50 | $3,584.35 | $12,036.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.12 / $163.44 / $351.18
| Professional | | $57.12 | $163.44 | $351.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $277.41 / $318.12 / $513.26
| Professional | 50 | $277.41 | $318.12 | $513.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.59 / $163.59 / $381.13
| Professional | | $163.59 | $163.59 | $381.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,630.88 / $6,276.04 / $11,781.72
| Facility | | $4,630.88 | $6,276.04 | $11,781.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.78 / $157.62 / $333.42
| Professional | | $73.78 | $157.62 | $333.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.51 / $328.45 / $509.34
| Professional | | $167.51 | $328.45 | $509.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.93 / $277.85 / $3,562.76
| Facility | | $105.93 | $277.85 | $3,562.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.56 / $402.98 / $616.92
| Professional | | $213.56 | $402.98 | $616.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.74 / $359.72 / $2,197.38
| Facility | | $184.74 | $359.72 | $2,197.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.48 / $328.45 / $473.56
| Professional | | $166.48 | $328.45 | $473.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $197.50 / $469.40
| Professional | | $5.00 | $197.50 | $469.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.56 / $382.84 / $462.14
| Professional | | $213.56 | $382.84 | $462.14 |