- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,090.30 / $6,309.57
| Facility | | $1,258.93 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $316.23
| Professional | | $100.00 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $234.42 / $933.25
| Professional | 50 | $154.88 | $234.42 | $933.25 |
- 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
- $107.15 / $120.23 / $239.88
| Professional | | $107.15 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $128.82 / $275.42
| Professional | | $93.33 | $128.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $186.21 / $1,949.84
| Facility | | $95.50 | $186.21 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $1,202.26
| Professional | | $104.71 | $147.91 | $1,202.26 |
- 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
- $91.20 / $114.82 / $194.98
| Professional | | $91.20 | $114.82 | $194.98 |