- 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
- $131.83 / $199.53 / $501.19
| Professional | | $131.83 | $199.53 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $478.63 / $1,479.11
| Professional | 50 | $295.12 | $478.63 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Professional | 50 | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $371.54 / $549.54
| Facility | | $114.82 | $371.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $144.54 / $288.40
| Professional | | $117.49 | $144.54 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $457.09 / $457.09
| Facility | | $151.36 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $190.55 / $331.13
| Professional | | $123.03 | $190.55 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $239.88 / $1,949.84
| Facility | | $134.90 | $239.88 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $234.42 / $1,479.11
| Professional | | $154.88 | $234.42 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | 50 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,122.02 / $2,187.76
| Facility | | $257.04 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $181.97 / $281.84
| Professional | | $128.82 | $181.97 | $281.84 |