- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.89 / $2,047.44 / $2,144.69
| Facility | | $727.89 | $2,047.44 | $2,144.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,159.23 / $2,159.23 / $4,289.38
| Facility | 50 | $2,159.23 | $2,159.23 | $4,289.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.76 / $237.53 / $727.90
| Professional | | $105.76 | $237.53 | $727.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.01 / $200.20 / $895.17
| Professional | | $120.01 | $200.20 | $895.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $180.01 / $300.30 / $1,342.75
| Professional | 50 | $180.01 | $300.30 | $1,342.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.51 / $316.70 / $1,113.86
| Professional | | $134.51 | $316.70 | $1,113.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.19 / $279.52 / $1,096.11
| Professional | | $121.19 | $279.52 | $1,096.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.44 / $2,047.44 / $2,144.69
| Facility | | $2,047.44 | $2,047.44 | $2,144.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,159.23 / $2,159.23 / $4,289.38
| Facility | 50 | $2,159.23 | $2,159.23 | $4,289.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.61 / $237.53 / $727.90
| Professional | | $108.61 | $237.53 | $727.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.08 / $712.29 / $1,203.42
| Professional | | $506.08 | $712.29 | $1,203.42 |