- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $2,884.03 / $10,964.78
| Facility | | $251.19 | $2,884.03 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $6,760.83 / $13,489.63
| Facility | 50 | $478.63 | $6,760.83 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $489.78 / $1,412.54
| Professional | | $269.15 | $489.78 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $1,047.13 / $2,818.38
| Professional | 50 | $741.31 | $1,047.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $331.13 / $660.69
| Professional | | $281.84 | $331.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $794.33 / $1,348.96
| Professional | 50 | $478.63 | $794.33 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $12,589.25 / $53,703.18
| Facility | | $173.78 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $467.74 / $1,202.26
| Professional | | $239.88 | $467.74 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,884.03 / $6,309.57
| Facility | | $1,905.46 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $389.05 / $1,071.52
| Professional | | $234.42 | $389.05 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,570.40 / $5,011.87
| Facility | | $537.03 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $1,174.90
| Professional | | $251.19 | $478.63 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $257.04 / $331.13
| Professional | | $229.09 | $257.04 | $331.13 |