- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $3,019.95 / $4,570.88
| Facility | | $251.19 | $3,019.95 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Facility | 50 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $501.19 / $1,174.90
| Professional | | $223.87 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,862.09
| Professional | 50 | $1,778.28 | $1,778.28 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $426.58 / $831.76
| Professional | | $229.09 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,230.27
| Professional | | $32.36 | $33.11 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $977.24 / $2,238.72
| Facility | | $831.76 | $977.24 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $3,388.44
| Facility | 50 | $1,258.93 | $1,479.11 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $1,096.48
| Professional | | $302.00 | $407.38 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $524.81 / $1,258.93
| Professional | | $229.09 | $524.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $478.63
| Professional | | $169.82 | $309.03 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $478.63 / $758.58
| Professional | | $323.59 | $478.63 | $758.58 |