- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.77 / $2,992.00 / $6,623.67
| Facility | | $567.77 | $2,992.00 | $6,623.67 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $231.84 / $3,835.50 / $3,835.50
| Facility | 50 | $231.84 | $3,835.50 | $3,835.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.06 / $390.72 / $580.41
| Professional | | $368.06 | $390.72 | $580.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.58 / $403.82 / $666.80
| Professional | | $272.58 | $403.82 | $666.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $939.97 / $939.97 / $939.97
| Professional | 50 | $939.97 | $939.97 | $939.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,864.79 / $6,060.22 / $9,454.41
| Facility | | $3,864.79 | $6,060.22 | $9,454.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.30 / $555.30 / $597.65
| Professional | | $413.30 | $555.30 | $597.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.09 / $1,491.09 / $1,491.09
| Facility | | $1,491.09 | $1,491.09 | $1,491.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.61 / $545.91 / $748.78
| Professional | | $391.61 | $545.91 | $748.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.72 / $586.98 / $4,244.47
| Facility | | $390.72 | $586.98 | $4,244.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.62 / $487.66 / $4,131.06
| Professional | | $375.62 | $487.66 | $4,131.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.05 / $452.56 / $646.45
| Professional | | $362.05 | $452.56 | $646.45 |