- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,202.26 / $2,691.53
| Facility | | $331.13 | $1,202.26 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $912.01 / $4,265.80 / $4,265.80
| Facility | 50 | $912.01 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $128.82 / $436.52
| Professional | | $69.18 | $128.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $50.12 / $275.42 / $724.44
| Professional | 50 | $50.12 | $275.42 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $104.71 / $144.54
| Professional | | $89.13 | $104.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.36 / $158.49 / $239.88
| Professional | 50 | $151.36 | $158.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $2,137.96
| Facility | | $724.44 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $144.54 / $245.47
| Professional | | $95.50 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $144.54 / $331.13
| Professional | | $95.50 | $144.54 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $1,288.25 / $1,288.25
| Facility | | $54.95 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $3,235.94
| Professional | | $1,698.24 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $120.23 / $234.42
| Professional | | $87.10 | $120.23 | $234.42 |