- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,630.27 / $7,762.47
| Facility | | $602.56 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $3,801.89 / $3,801.89
| Facility | 50 | $234.42 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $446.68 / $1,071.52
| Professional | | $389.05 | $446.68 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $933.25 / $1,258.93 / $1,949.84
| Professional | 50 | $933.25 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $549.54
| Professional | | $208.93 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.08 / $588.84 / $891.25
| Professional | 50 | $363.08 | $588.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,623.41 / $8,912.51
| Facility | | $3,630.78 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $575.44
| Professional | | $416.87 | $524.81 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $776.25
| Professional | | $426.58 | $549.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $4,786.30
| Facility | | $398.11 | $602.56 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $4,168.69
| Professional | | $363.08 | $489.78 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $5,888.44
| Facility | | $891.25 | $3,235.94 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $426.58 / $575.44
| Professional | | $346.74 | $426.58 | $575.44 |