- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,890.45 / $10,471.29
| Facility | | $575.44 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.58 / $3,890.45 / $10,471.29
| Facility | 50 | $0.58 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $933.25
| Professional | | $354.81 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,309.57 / $12,302.69
| Facility | | $2,398.83 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $912.01
| Professional | | $316.23 | $467.74 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,479.11 / $3,467.37
| Facility | | $602.56 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,318.26
| Professional | | $346.74 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $870.96
| Professional | | $316.23 | $467.74 | $870.96 |