- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,398.83 / $8,709.64
| Facility | | $645.65 | $2,398.83 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,311.31 / $8,317.64 / $9,549.93
| Facility | 50 | $3,311.31 | $8,317.64 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $1,047.13
| Professional | | $398.11 | $537.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $1,584.89 / $2,238.72
| Professional | 50 | $281.84 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Professional | 50 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $1,096.48
| Professional | | $416.87 | $575.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,148.15
| Professional | | $407.38 | $588.84 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $977.24
| Facility | | $426.58 | $575.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,244.36 / $10,471.29
| Facility | | $1,995.26 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $977.24
| Professional | | $371.54 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $33,884.42
| Facility | | $5,754.40 | $5,754.40 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Professional | | $5,623.41 | $5,623.41 | $5,623.41 |