- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $3,630.78 / $7,943.28
| Facility | | $169.82 | $3,630.78 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $120.23 / $223.87
| Professional | | $72.44 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | 50 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $645.65
| Facility | | $323.59 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $208.93
| Professional | | $123.03 | $123.03 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $151.36 / $263.03
| Professional | | $87.10 | $151.36 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $173.78 / $1,288.25
| Facility | | $77.62 | $173.78 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $194.98 / $1,000.00
| Professional | | $134.90 | $194.98 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $2,570.40
| Facility | | $512.86 | $794.33 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $134.90 / $208.93
| Professional | | $85.11 | $134.90 | $208.93 |