- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $3,981.07
| Facility | | $467.74 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 50 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $323.59 / $912.01
| Professional | | $112.20 | $323.59 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $575.44 / $588.84
| Professional | 50 | $346.74 | $575.44 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $93.33 / $245.47
| Professional | | $52.48 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $75.86 / $77.62
| Professional | 50 | $75.86 | $75.86 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $1,621.81
| Facility | | $109.65 | $151.36 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $354.81 / $1,071.52
| Professional | | $134.90 | $354.81 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $562.34
| Facility | | $151.36 | $151.36 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $269.15 / $933.25
| Professional | | $125.89 | $269.15 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $8,709.64 / $8,709.64
| Facility | | $54.95 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $302.00 / $1,000.00
| Professional | | $114.82 | $302.00 | $1,000.00 |