- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,348.96 / $6,606.93
| Facility | | $151.36 | $1,348.96 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $120.23 / $1,047.13
| Professional | | $58.88 | $120.23 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $707.95 / $1,819.70
| Facility | | $213.80 | $707.95 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $245.47 / $707.95 / $2,754.23
| Facility | 50 | $245.47 | $707.95 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $229.09
| Professional | | $107.15 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $158.49 / $194.98 / $338.84
| Professional | 50 | $158.49 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $102.33 / $162.18
| Professional | | $72.44 | $102.33 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $141.25 / $295.12
| Facility | | $70.79 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $151.36 / $269.15
| Professional | | $100.00 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $2,238.72
| Facility | | $1,230.27 | $1,548.82 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $2,630.27 / $3,388.44
| Facility | 50 | $1,862.09 | $2,630.27 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $128.82 / $234.42
| Professional | | $70.79 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $125.89 / $1,047.13
| Professional | | $81.28 | $125.89 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,630.27 / $4,466.84
| Facility | | $446.68 | $2,630.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $112.20 / $194.98
| Professional | | $69.18 | $112.20 | $194.98 |