- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,047.13 / $4,365.16
| Facility | | $346.74 | $1,047.13 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 50 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $562.34
| Professional | | $112.20 | $218.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | 50 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $257.04
| Professional | | $229.09 | $229.09 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $263.03
| Facility | | $239.88 | $239.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $245.47 / $245.47
| Professional | | $218.78 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $177.83 / $1,174.90
| Facility | | $158.49 | $177.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $407.38
| Professional | | $141.25 | $229.09 | $407.38 |
- 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
- $457.09 / $1,000.00 / $1,862.09
| Facility | | $457.09 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $223.87 / $512.86
| Professional | | $104.71 | $223.87 | $512.86 |