- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | 50 | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $302.00 / $588.84
| Professional | | $165.96 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $478.63 / $1,230.27
| Professional | 50 | $407.38 | $478.63 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $81,283.05 / $95,499.26
| Facility | | $46,773.51 | $81,283.05 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $407.38
| Professional | | $251.19 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $269.15 / $426.58
| Professional | | $208.93 | $269.15 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $562.34
| Facility | | $275.42 | $436.52 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $562.34
| Professional | | $275.42 | $436.52 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $549.54
| Facility | | $173.78 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $251.19 / $512.86
| Professional | | $79.43 | $251.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $371.54 / $588.84
| Professional | | $251.19 | $371.54 | $588.84 |