- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,388.44 / $5,623.41
| Facility | | $602.56 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $1,348.96
| Professional | | $478.63 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $316.23 / $3,090.30 / $3,388.44
| Professional | 50 | $316.23 | $3,090.30 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $11,220.18
| Facility | | $1,122.02 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $1,905.46
| Professional | | $457.09 | $794.33 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,288.25
| Facility | | $562.34 | $562.34 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $977.24 / $1,380.38
| Professional | | $562.34 | $977.24 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $1,995.26
| Professional | 50 | $1,288.25 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $954.99 / $1,819.70
| Professional | | $512.86 | $954.99 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $891.25 / $7,079.46
| Facility | | $416.87 | $891.25 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $1,202.26
| Professional | | $691.83 | $870.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,772.37
| Facility | | $1,698.24 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,621.81
| Professional | | $489.78 | $794.33 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,122.02
| Professional | | $371.54 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $11,220.18
| Facility | | $1,122.02 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $1,862.09
| Professional | | $457.09 | $794.33 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,120.11
| Facility | | $1,698.24 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $831.76 / $1,621.81
| Professional | | $512.86 | $831.76 | $1,621.81 |