- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.39 / $2,235.48 / $8,399.04
| Facility | | $489.39 | $2,235.48 | $8,399.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,469.18 / $8,469.18 / $8,469.18
| Facility | 50 | $8,469.18 | $8,469.18 | $8,469.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.12 / $718.94 / $1,415.81
| Professional | | $250.12 | $718.94 | $1,415.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $522.63 / $522.63 / $522.63
| Professional | 50 | $522.63 | $522.63 | $522.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.91 / $101.91 / $233.92
| Professional | | $101.91 | $101.91 | $233.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $150.00 / $4,365.00
| Facility | | $110.00 | $150.00 | $4,365.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.51 / $704.65 / $1,839.88
| Professional | | $312.51 | $704.65 | $1,839.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.31 / $424.16 / $933.14
| Facility | | $332.31 | $424.16 | $933.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.52 / $574.22 / $1,796.43
| Professional | | $276.52 | $574.22 | $1,796.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,657.92 / $1,657.92 / $8,980.00
| Facility | | $1,657.92 | $1,657.92 | $8,980.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,032.60 / $7,304.82 / $7,523.96
| Professional | | $3,032.60 | $7,304.82 | $7,523.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $814.00 / $2,495.00
| Facility | | $296.00 | $814.00 | $2,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.90 / $1,279.94 / $1,987.04
| Professional | | $772.90 | $1,279.94 | $1,987.04 |