- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,288.25 / $2,691.53
| Facility | | $467.74 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $2,089.30 / $3,548.13
| Facility | 50 | $501.19 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $169.82 / $398.11
| Professional | | $85.11 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $125.89 / $288.40 / $933.25
| Professional | 50 | $125.89 | $288.40 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $123.03 / $239.88
| Professional | | $83.18 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $125.89 / $234.42 / $380.19
| Professional | 50 | $125.89 | $234.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $2,137.96
| Facility | | $724.44 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $338.84
| Professional | | $109.65 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $181.97 / $302.00
| Professional | | $97.72 | $181.97 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $30,199.52
| Facility | | $2,691.53 | $2,691.53 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,445.44 / $2,884.03
| Facility | | $741.31 | $1,445.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $162.18 / $323.59
| Professional | | $85.11 | $162.18 | $323.59 |