- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $223.87 / $467.74
| Professional | | $131.83 | $223.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,096.48 / $3,019.95
| Facility | | $263.03 | $1,096.48 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $288.40 / $426.58
| Professional | | $218.78 | $288.40 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $302.00 / $436.52 / $630.96
| Professional | 50 | $302.00 | $436.52 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $204.17 / $371.54
| Professional | | $107.15 | $204.17 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $257.04 / $660.69
| Facility | | $107.15 | $257.04 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $416.87
| Professional | | $144.54 | $245.47 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,290.87 / $3,162.28
| Facility | | $1,819.70 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $446.68
| Professional | | $218.78 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $1,548.82
| Professional | | $144.54 | $218.78 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,467.37 / $7,762.47
| Facility | | $501.19 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $389.05
| Professional | | $144.54 | $234.42 | $389.05 |