- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,698.24 / $6,606.93
| Facility | | $457.09 | $1,698.24 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $707.95 / $1,548.82 / $24,547.09
| Facility | 50 | $707.95 | $1,548.82 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $295.12
| Professional | | $144.54 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | 50 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $3,715.35
| Facility | | $1,479.11 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $208.93
| Professional | | $151.36 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $251.19
| Professional | | $162.18 | $208.93 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $1,862.09 / $5,495.41
| Facility | | $177.83 | $1,862.09 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $186.21 / $2,511.89
| Professional | | $141.25 | $186.21 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $5,754.40
| Facility | | $891.25 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $169.82 / $251.19
| Professional | | $134.90 | $169.82 | $251.19 |