- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,090.30 / $7,943.28
| Facility | | $660.69 | $3,090.30 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $7,943.28 / $7,943.28
| Facility | 50 | $4,168.69 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $239.88 / $524.81
| Professional | | $120.23 | $239.88 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $416.87 / $1,318.26
| Professional | 50 | $309.03 | $416.87 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $194.98 / $371.54
| Professional | | $114.82 | $194.98 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $354.81 / $426.58
| Professional | 50 | $218.78 | $354.81 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $478.63 / $1,318.26
| Facility | | $223.87 | $478.63 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $234.42 / $457.09
| Professional | | $123.03 | $234.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,235.94 / $6,606.93
| Facility | | $2,137.96 | $3,235.94 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $218.78 / $302.00
| Professional | | $147.91 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $100.00 / $354.81
| Professional | | $32.36 | $100.00 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,570.40 / $5,011.87
| Facility | | $588.84 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $204.17 / $398.11
| Professional | | $104.71 | $204.17 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $204.17 / $295.12
| Professional | | $100.00 | $204.17 | $295.12 |