- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,818.38 / $8,912.51
| Facility | | $223.87 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $831.76 / $1,380.38 / $6,456.54
| Facility | 50 | $831.76 | $1,380.38 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $162.18 / $426.58
| Professional | | $102.33 | $162.18 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $213.80 / $645.65 / $1,023.29
| Professional | 50 | $213.80 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $158.49 / $323.59
| Professional | | $102.33 | $158.49 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.36 / $223.87 / $426.58
| Professional | 50 | $151.36 | $223.87 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $281.84 / $1,202.26
| Facility | | $89.13 | $281.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $213.80 / $426.58
| Professional | | $123.03 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $323.59
| Professional | | $102.33 | $173.78 | $323.59 |