- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $1,288.25 / $2,818.38
| Facility | | $181.97 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $776.25 / $1,737.80 / $7,762.47
| Facility | 50 | $776.25 | $1,737.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $676.08
| Professional | | $181.97 | $309.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $630.96 / $630.96 / $2,884.03
| Professional | 50 | $630.96 | $630.96 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $97.72 / $173.78 / $537.03
| Professional | 50 | $97.72 | $173.78 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $3,388.44
| Facility | | $1,445.44 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $407.38 / $630.96
| Professional | | $190.55 | $407.38 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,691.53 / $6,606.93
| Facility | | $724.44 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $371.54 / $776.25
| Professional | | $169.82 | $371.54 | $776.25 |