- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.77 / $1,188.90 / $1,354.65
| Facility | | $82.77 | $1,188.90 | $1,354.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,288.36 / $1,949.40 / $2,318.04
| Facility | 50 | $1,288.36 | $1,949.40 | $2,318.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.23 / $182.27 / $990.00
| Professional | | $64.23 | $182.27 | $990.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $117.78 / $292.83 / $932.85
| Professional | 50 | $117.78 | $292.83 | $932.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.34 / $235.68 / $477.20
| Professional | | $171.34 | $235.68 | $477.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.02 / $227.14 / $418.68
| Facility | | $117.02 | $227.14 | $418.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,395.62 / $1,395.62 / $1,395.62
| Facility | 50 | $1,395.62 | $1,395.62 | $1,395.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.57 / $368.95 / $2,255.51
| Professional | | $175.57 | $368.95 | $2,255.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.96 / $251.32 / $447.39
| Facility | | $181.96 | $251.32 | $447.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.50 / $257.00 / $410.74
| Professional | | $172.50 | $257.00 | $410.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $226.00 / $318.27
| Professional | | $137.47 | $226.00 | $318.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $821.00 / $821.00
| Facility | | $821.00 | $821.00 | $821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.57 / $294.14 / $457.55
| Professional | | $175.57 | $294.14 | $457.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.40 / $196.30 / $386.30
| Professional | | $160.40 | $196.30 | $386.30 |