- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $9,772.37
| Facility | | $338.84 | $489.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $380.19
| Professional | | $83.18 | $120.23 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,412.54 / $2,630.27
| Facility | | $1,288.25 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $169.82 / $275.42
| Professional | | $77.62 | $169.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.82 / $257.04 / $407.38
| Professional | 50 | $114.82 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $354.81
| Professional | | $107.15 | $173.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $162.18 / $316.23
| Professional | | $93.33 | $162.18 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $331.13
| Professional | | $114.82 | $173.78 | $331.13 |