- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $3,019.95 / $4,897.79
| Facility | | $169.82 | $3,019.95 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $208.93 / $794.33
| Professional | | $112.20 | $208.93 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.08 / $1,148.15 / $1,513.56
| Professional | 50 | $363.08 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,023.29 / $13,489.63
| Facility | | $302.00 | $1,023.29 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $234.42 / $588.84
| Professional | | $125.89 | $234.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $331.13
| Facility | | $144.54 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $398.11
| Professional | | $141.25 | $229.09 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $575.44
| Professional | | $151.36 | $295.12 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $380.19 / $7,079.46
| Facility | | $114.82 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $436.52
| Professional | | $229.09 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $234.42 / $501.19
| Professional | | $134.90 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $354.81
| Professional | | $338.84 | $338.84 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,071.52 / $13,489.63
| Facility | | $302.00 | $1,071.52 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $229.09 / $575.44
| Professional | | $125.89 | $229.09 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $251.19 / $512.86
| Professional | | $134.90 | $251.19 | $512.86 |