- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,290.87 / $9,772.37
| Facility | | $549.54 | $2,290.87 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $912.01 / $3,162.28 / $7,079.46
| Facility | 50 | $912.01 | $3,162.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $371.54 / $1,096.48
| Professional | | $93.33 | $371.54 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $302.00 / $2,570.40
| Professional | 50 | $141.25 | $302.00 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $128.82 / $165.96
| Professional | | $79.43 | $128.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $128.82 / $138.04 / $245.47
| Professional | 50 | $128.82 | $138.04 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $933.25 / $1,148.15
| Facility | | $34.67 | $933.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $371.54 / $977.24
| Professional | | $100.00 | $371.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,888.44 / $11,481.54
| Facility | | $3,162.28 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $407.38 / $512.86
| Professional | | $380.19 | $407.38 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $660.69
| Professional | | $32.36 | $33.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,570.40 / $5,011.87
| Facility | | $537.03 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $363.08 / $870.96
| Professional | | $93.33 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $436.52 / $549.54
| Professional | | $75.86 | $436.52 | $549.54 |