- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,445.44 / $2,454.71
| Facility | | $338.84 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $3,715.35
| Facility | 50 | $1,148.15 | $1,412.54 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $269.15 / $645.65
| Professional | | $107.15 | $269.15 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $177.83 / $407.38 / $1,096.48
| Professional | 50 | $177.83 | $407.38 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $165.96 / $263.03
| Professional | | $100.00 | $165.96 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $251.19 / $380.19
| Professional | 50 | $147.91 | $251.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $257.04 / $524.81
| Professional | | $128.82 | $257.04 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Professional | 53 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $323.59 / $524.81
| Professional | | $123.03 | $323.59 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,548.82 / $2,454.71
| Facility | | $323.59 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $3,715.35
| Facility | 50 | $1,148.15 | $1,513.56 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $263.03 / $562.34
| Professional | | $112.20 | $263.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $177.83 / $407.38 / $1,096.48
| Professional | 50 | $177.83 | $407.38 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $457.09
| Professional | | $109.65 | $218.78 | $457.09 |