- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,019.95 / $5,754.40
| Facility | | $245.47 | $3,019.95 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,089.30 / $2,238.72 / $6,606.93
| Facility | 50 | $2,089.30 | $2,238.72 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $194.98 / $630.96
| Professional | | $83.18 | $194.98 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $83.18 / $295.12 / $831.76
| Professional | 50 | $83.18 | $295.12 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $288.40
| Professional | | $97.72 | $177.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $177.83
| Professional | | $32.36 | $33.11 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $3,630.78
| Facility | | $1,348.96 | $1,584.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $5,370.32
| Facility | 50 | $2,041.74 | $2,398.83 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $457.09
| Professional | | $144.54 | $269.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $199.53 / $371.54
| Professional | | $102.33 | $199.53 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $257.04 / $346.74
| Professional | | $125.89 | $257.04 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $151.36 / $269.15
| Professional | | $81.28 | $151.36 | $269.15 |