- 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
- $245.47 / $467.74 / $1,230.27
| Professional | | $245.47 | $467.74 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $645.65 / $1,862.09 / $3,630.78
| Professional | 50 | $645.65 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $218.78 / $295.12
| Professional | | $190.55 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | 50 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $218.78 / $436.52
| Professional | | $194.98 | $218.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $426.58 / $1,148.15
| Professional | | $208.93 | $426.58 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $467.74 / $2,691.53
| Facility | | $223.87 | $467.74 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $537.03 / $2,951.21
| Professional | | $389.05 | $537.03 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,513.56 / $3,235.94
| Facility | | $467.74 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $676.08
| Professional | | $371.54 | $467.74 | $676.08 |