- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,466.84 / $8,317.64
| Facility | | $1,000.00 | $4,466.84 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $169.82 / $707.95
| Professional | | $72.44 | $169.82 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $691.83 / $1,584.89
| Professional | 50 | $154.88 | $691.83 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $87.10
| Professional | | $77.62 | $77.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $204.17 / $537.03
| Professional | | $85.11 | $204.17 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $213.80 / $338.84
| Professional | | $117.49 | $213.80 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,120.11 / $14,454.40
| Facility | | $5,754.40 | $9,120.11 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $173.78 / $338.84
| Professional | | $63.10 | $173.78 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,128.61 / $9,120.11
| Facility | | $2,511.89 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $144.54 / $309.03
| Professional | | $61.66 | $144.54 | $309.03 |