- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,398.83 / $6,309.57
| Facility | | $380.19 | $2,398.83 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,187.76 / $7,762.47 / $11,481.54
| Facility | 50 | $2,187.76 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $1,479.11
| Professional | | $302.00 | $416.87 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $933.25 / $2,187.76 / $9,549.93
| Professional | 50 | $933.25 | $2,187.76 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $977.24
| Professional | | $281.84 | $407.38 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $371.54 / $1,659.59
| Professional | 50 | $371.54 | $371.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $912.01 / $1,513.56
| Professional | | $323.59 | $912.01 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $1,380.38 / $2,238.72
| Professional | 50 | $478.63 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $1,122.02
| Professional | | $263.03 | $354.81 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $389.05
| Facility | | $190.55 | $190.55 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $1,513.56
| Professional | | $269.15 | $512.86 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $831.76 / $2,454.71
| Facility | | $54.95 | $831.76 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $741.31 / $5,248.07
| Professional | | $331.13 | $741.31 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,047.13 / $2,187.76
| Facility | | $416.87 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $1,148.15
| Professional | | $295.12 | $457.09 | $1,148.15 |