- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.56 / $1,083.00 / $3,001.66
| Facility | | $240.56 | $1,083.00 | $3,001.66 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,471.46 / $3,063.00 / $6,666.51
| Facility | 50 | $2,471.46 | $3,063.00 | $6,666.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.40 / $223.58 / $329.73
| Professional | | $157.40 | $223.58 | $329.73 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $549.50 / $843.60 / $1,397.53
| Professional | 50 | $549.50 | $843.60 | $1,397.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.78 / $1,625.78 / $1,950.94
| Facility | | $1,625.78 | $1,625.78 | $1,950.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.38 / $235.85 / $339.37
| Professional | | $160.38 | $235.85 | $339.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.33 / $228.33 / $228.33
| Facility | | $228.33 | $228.33 | $228.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.76 / $307.58 / $555.26
| Professional | | $295.76 | $307.58 | $555.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.42 / $2,185.42 / $2,185.42
| Facility | | $2,185.42 | $2,185.42 | $2,185.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.42 / $302.13 / $469.57
| Professional | | $211.42 | $302.13 | $469.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.00 / $1,230.00 / $2,558.00
| Facility | | $590.00 | $1,230.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.19 / $313.85 / $499.49
| Professional | | $234.19 | $313.85 | $499.49 |