- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,862.09 / $6,456.54
| Facility | | $229.09 | $1,862.09 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 50 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $416.87
| Professional | | $158.49 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Professional | 50 | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $257.04 / $323.59
| Professional | | $158.49 | $257.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $416.87 / $446.68 / $501.19
| Professional | 50 | $416.87 | $446.68 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $3,630.78
| Facility | | $1,479.11 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $331.13
| Professional | | $173.78 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $426.58
| Professional | | $169.82 | $275.42 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $501.19 / $4,073.80
| Facility | | $186.21 | $501.19 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $3,388.44
| Professional | | $223.87 | $346.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,801.89
| Facility | | $575.44 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $380.19
| Professional | | $147.91 | $234.42 | $380.19 |