- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,715.35 / $4,570.88
| Facility | | $1,659.59 | $3,715.35 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $128.82 / $269.15
| Professional | | $70.79 | $128.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $112.20 / $144.54
| Facility | | $87.10 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $371.54
| Professional | | $154.88 | $251.19 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $1,318.26
| Facility | | $144.54 | $144.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $162.18 / $1,000.00
| Professional | | $81.28 | $162.18 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,801.89 / $6,760.83
| Facility | | $2,137.96 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | 50 | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $4,570.88
| Facility | | $1,230.27 | $1,230.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $112.20 / $199.53
| Professional | | $60.26 | $112.20 | $199.53 |