- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,698.24 / $3,715.35
| Facility | | $457.09 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $323.59 / $1,412.54 / $6,025.60
| Facility | 50 | $323.59 | $1,412.54 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $416.87 / $776.25
| Professional | | $181.97 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $954.99 / $1,318.26
| Professional | 50 | $281.84 | $954.99 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $354.81 / $812.83
| Professional | | $169.82 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $269.15 / $354.81 / $645.65
| Professional | 50 | $269.15 | $354.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,000.00
| Professional | | $812.83 | $812.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $954.99 / $2,570.40
| Facility | | $851.14 | $954.99 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $457.09 / $812.83
| Professional | | $269.15 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,344.23 / $6,165.95
| Facility | | $794.33 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $416.87 / $870.96
| Professional | | $208.93 | $416.87 | $870.96 |