- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,819.70 / $3,981.07
| Facility | | $524.81 | $1,819.70 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $316.23 / $812.83
| Professional | | $190.55 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $630.96 / $776.25
| Professional | 50 | $281.84 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $234.42
| Professional | | $165.96 | $223.87 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $234.42 / $512.86
| Professional | 50 | $234.42 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,548.82 / $2,454.71
| Facility | | $724.44 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $501.19
| Professional | | $208.93 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $524.81
| Professional | | $218.78 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,951.21 / $2,951.21
| Facility | | $54.95 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | 54 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,445.44 / $2,884.03
| Facility | | $741.31 | $1,445.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $489.78
| Professional | | $199.53 | $302.00 | $489.78 |