- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $575.44 / $575.44
| Facility | | $186.21 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $446.68 / $794.33
| Professional | | $177.83 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $436.52 / $1,819.70 / $1,819.70
| Professional | 50 | $436.52 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $7,079.46 / $16,982.44
| Facility | | $1,071.52 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,709.64 / $15,488.17 / $39,810.72
| Facility | 50 | $8,709.64 | $15,488.17 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $724.44 / $1,659.59
| Professional | | $309.03 | $724.44 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $1,023.29 / $2,398.83
| Professional | 50 | $457.09 | $1,023.29 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,995.26 / $4,677.35
| Facility | | $1,230.27 | $1,995.26 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $891.25 / $2,187.76
| Professional | | $389.05 | $891.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $3,715.35
| Facility | | $1,513.56 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $870.96 / $2,089.30
| Professional | | $389.05 | $870.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $776.25 / $7,762.47
| Facility | | $239.88 | $776.25 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,122.02 / $2,951.21
| Professional | | $630.96 | $1,122.02 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,370.32 / $9,332.54
| Facility | | $1,584.89 | $5,370.32 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $691.83 / $1,737.80
| Professional | | $263.03 | $691.83 | $1,737.80 |