- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $2,089.30 / $3,801.89
| Facility | | $181.97 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $4,365.16 / $5,754.40
| Facility | 50 | $812.83 | $4,365.16 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $173.78 / $758.58 / $1,023.29
| Professional | 50 | $173.78 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $724.44 / $2,818.38
| Facility | | $56.23 | $724.44 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $316.23
| Facility | | $134.90 | $134.90 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $218.78 / $7,079.46
| Facility | | $104.71 | $218.78 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,041.74 / $4,365.16
| Facility | | $933.25 | $2,041.74 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $724.44 / $2,818.38
| Facility | | $56.23 | $724.44 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,818.38
| Facility | | $501.19 | $1,862.09 | $2,818.38 |