- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $2,089.30 / $3,801.89
| Facility | | $120.23 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $125.89 / $380.19
| Professional | | $60.26 | $125.89 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $144.54 / $144.54 / $630.96
| Professional | 50 | $144.54 | $144.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $1,862.09 / $19,498.45
| Facility | | $141.25 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $154.88 / $407.38
| Professional | | $64.57 | $154.88 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $165.96
| Facility | | $70.79 | $70.79 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $204.17 / $371.54
| Professional | | $91.20 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $147.91 / $302.00
| Professional | | $77.62 | $147.91 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $112.20 / $7,079.46
| Facility | | $56.23 | $112.20 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $204.17 / $275.42
| Professional | | $165.96 | $204.17 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $147.91 / $363.08
| Professional | | $64.57 | $147.91 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $1,862.09 / $19,498.45
| Facility | | $134.90 | $1,862.09 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $154.88 / $407.38
| Professional | | $64.57 | $154.88 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $151.36 / $346.74
| Professional | | $70.79 | $151.36 | $346.74 |