- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $3,630.78 / $8,317.64
| Facility | | $331.13 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $446.68
| Professional | | $158.49 | $257.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $426.58 / $524.81 / $2,398.83
| Professional | 50 | $426.58 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $436.52
| Professional | | $165.96 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $354.81 / $457.09
| Professional | 50 | $295.12 | $354.81 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $2,137.96
| Facility | | $977.24 | $2,041.74 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $436.52
| Professional | | $275.42 | $275.42 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $489.78
| Professional | | $165.96 | $275.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $446.68 / $3,890.45
| Facility | | $208.93 | $446.68 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $3,388.44
| Professional | | $251.19 | $380.19 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $3,311.31
| Facility | | $1,023.29 | $1,380.38 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $263.03 / $407.38
| Professional | | $169.82 | $263.03 | $407.38 |