- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $134.90 / $407.38
| Professional | | $74.13 | $134.90 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $346.74 / $870.96
| Professional | 50 | $199.53 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $123.03
| Professional | | $102.33 | $102.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $331.13 / $489.78
| Facility | | $102.33 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $93.33 / $186.21
| Professional | | $53.70 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $251.19
| Professional | | $85.11 | $144.54 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $138.04 / $1,862.09
| Facility | | $74.13 | $138.04 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $190.55 / $1,000.00
| Professional | | $125.89 | $190.55 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,513.56 / $3,235.94
| Facility | | $588.84 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $128.82 / $213.80
| Professional | | $75.86 | $128.82 | $213.80 |