- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,365.16 / $7,413.10
| Facility | | $1,445.44 | $4,365.16 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $162.18 / $371.54
| Professional | | $104.71 | $162.18 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $676.08 / $954.99
| Professional | 50 | $501.19 | $676.08 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | 50 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,089.30 / $3,548.13
| Facility | | $758.58 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $181.97 / $263.03
| Professional | | $134.90 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $281.84 / $398.11
| Professional | 50 | $199.53 | $281.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $2,511.89
| Facility | | $117.49 | $186.21 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $229.09 / $407.38
| Professional | | $131.83 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $194.98 / $1,288.25
| Professional | | $107.15 | $194.98 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Professional | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,187.76 / $3,467.37
| Facility | | $426.58 | $2,187.76 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $331.13
| Professional | | $112.20 | $186.21 | $331.13 |