- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $8,709.64 / $16,595.87
| Facility | | $426.58 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 50 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,548.82 / $2,570.40
| Professional | | $154.88 | $1,548.82 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $125.89 / $1,122.02 / $3,311.31
| Professional | 50 | $125.89 | $1,122.02 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $954.99 / $1,047.13 / $2,238.72
| Professional | 50 | $954.99 | $1,047.13 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,370.32 / $10,232.93
| Facility | | $2,570.40 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $1,513.56 / $2,398.83
| Professional | | $134.90 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $5,011.87
| Facility | | $3,890.45 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $426.58 / $3,311.31
| Professional | | $204.17 | $426.58 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,479.11 / $3,715.35
| Facility | | $173.78 | $1,479.11 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $13,182.57 / $23,988.33
| Facility | | $5,128.61 | $13,182.57 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,348.96 / $3,548.13
| Professional | | $154.88 | $1,348.96 | $3,548.13 |