- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.23 / $861.66 / $1,698.41
| Facility | | $106.23 | $861.66 | $1,698.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,292.49 / $1,546.62 / $2,603.64
| Facility | 50 | $1,292.49 | $1,546.62 | $2,603.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.41 / $157.28 / $233.94
| Professional | | $84.41 | $157.28 | $233.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,870.45 / $1,870.45 / $2,992.72
| Professional | 50 | $1,870.45 | $1,870.45 | $2,992.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.49 / $115.87 / $178.91
| Professional | | $98.49 | $115.87 | $178.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.72 / $173.81 / $268.36
| Professional | 50 | $147.72 | $173.81 | $268.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.98 / $197.10 / $360.57
| Professional | | $111.98 | $197.10 | $360.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.53 / $219.29 / $352.05
| Professional | | $112.53 | $219.29 | $352.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.42 / $1,141.79 / $1,724.62
| Facility | | $287.42 | $1,141.79 | $1,724.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $308.74 / $1,546.62 / $2,558.83
| Facility | 50 | $308.74 | $1,546.62 | $2,558.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.73 / $159.12 / $248.23
| Professional | | $95.73 | $159.12 | $248.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,870.45 / $1,870.45 / $2,992.72
| Professional | 50 | $1,870.45 | $1,870.45 | $2,992.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.12 / $231.17 / $361.43
| Professional | | $165.12 | $231.17 | $361.43 |