- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $741.31 / $1,737.80
| Facility | | $162.18 | $741.31 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $588.84 / $1,023.29 / $2,187.76
| Facility | 50 | $588.84 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $467.74
| Professional | | $102.33 | $213.80 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $588.84 / $912.01
| Professional | 50 | $162.18 | $588.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $489.78
| Professional | | $134.90 | $186.21 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $251.19 / $281.84
| Professional | 50 | $138.04 | $251.19 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,412.54 / $1,905.46
| Facility | | $1,174.90 | $1,412.54 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,778.28 / $2,089.30 / $2,818.38
| Facility | 50 | $1,778.28 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $309.03
| Professional | | $144.54 | $234.42 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $371.54
| Professional | | $109.65 | $194.98 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,174.90 / $2,511.89
| Facility | | $407.38 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $162.18 / $371.54
| Professional | | $87.10 | $162.18 | $371.54 |