- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $6,825.52 / $14,552.94
| Facility | | $0.98 | $6,825.52 | $14,552.94 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,007.60 / $5,007.60 / $23,827.82
| Facility | 50 | $5,007.60 | $5,007.60 | $23,827.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.72 / $348.51 / $1,152.28
| Professional | | $191.72 | $348.51 | $1,152.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $655.27 / $655.27 / $655.27
| Professional | 50 | $655.27 | $655.27 | $655.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.91 / $559.91 / $795.96
| Professional | | $559.91 | $559.91 | $795.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.85 / $1,118.89 / $1,613.19
| Facility | | $206.85 | $1,118.89 | $1,613.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.75 / $1,056.30 / $1,637.46
| Professional | | $406.75 | $1,056.30 | $1,637.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.35 / $966.25 / $1,472.00
| Professional | | $676.35 | $966.25 | $1,472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.85 / $1,118.89 / $1,613.19
| Facility | | $206.85 | $1,118.89 | $1,613.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.58 / $882.45 / $1,472.00
| Professional | | $340.58 | $882.45 | $1,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.11 / $660.30 / $1,518.69
| Professional | | $620.11 | $660.30 | $1,518.69 |