- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,398.83 / $9,772.37
| Facility | | $676.08 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | 50 | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $275.42 / $588.84
| Professional | | $158.49 | $275.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $467.74 / $1,348.96 / $1,659.59
| Professional | 50 | $467.74 | $1,348.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,737.80 / $3,019.95
| Facility | | $1,584.89 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $263.03 / $380.19
| Professional | | $138.04 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $208.93 / $398.11 / $562.34
| Professional | 50 | $208.93 | $398.11 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $724.44
| Professional | | $223.87 | $389.05 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $323.59 / $660.69
| Professional | | $165.96 | $323.59 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $676.08
| Professional | | $213.80 | $363.08 | $676.08 |