- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,691.53 / $7,413.10
| Facility | | $302.00 | $2,691.53 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $2,570.40 / $6,456.54
| Facility | 50 | $812.83 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $478.63
| Professional | | $173.78 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.10 / $489.78 / $831.76
| Professional | 50 | $87.10 | $489.78 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $2,238.72
| Professional | | $154.88 | $154.88 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $97.72 / $125.89 / $204.17
| Professional | 50 | $97.72 | $125.89 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,890.45 / $4,073.80
| Facility | | $933.25 | $3,890.45 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $501.19
| Professional | | $436.52 | $436.52 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $645.65
| Professional | | $186.21 | $295.12 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $602.56 / $6,456.54
| Facility | | $218.78 | $602.56 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $3,801.89
| Professional | | $281.84 | $446.68 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,570.40 / $4,677.35
| Facility | | $1,548.82 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $346.74 / $501.19
| Professional | | $194.98 | $346.74 | $501.19 |