- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,454.71 / $6,456.54
| Facility | | $891.25 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | 50 | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $676.08 / $1,348.96
| Professional | | $281.84 | $676.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $891.25 / $3,890.45
| Professional | 50 | $281.84 | $891.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $346.74 / $812.83
| Professional | | $275.42 | $346.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $616.60 / $1,862.09
| Professional | 50 | $478.63 | $616.60 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,606.93 / $9,772.37
| Facility | | $2,187.76 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $933.25 / $2,570.40
| Professional | | $398.11 | $933.25 | $2,570.40 |
- 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
- $331.13 / $707.95 / $1,513.56
| Professional | | $331.13 | $707.95 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $29,512.09 / $45,708.82
| Facility | | $29,512.09 | $29,512.09 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $8,317.64
| Professional | | $7,762.47 | $7,762.47 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,709.64 / $29,512.09
| Facility | | $4,365.16 | $8,709.64 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $676.08 / $1,479.11
| Professional | | $295.12 | $676.08 | $1,479.11 |