- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $2,238.72 / $4,168.69
| Facility | | $173.78 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $3,715.35
| Facility | 50 | $2,754.23 | $2,754.23 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $173.78 / $467.74
| Professional | | $95.50 | $173.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,584.89 / $4,570.88
| Facility | | $56.23 | $1,584.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $208.93 / $562.34
| Professional | | $97.72 | $208.93 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $263.03
| Facility | | $112.20 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $213.80 / $426.58
| Professional | | $112.20 | $213.80 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $251.19 / $478.63
| Professional | | $120.23 | $251.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $177.83 / $7,079.46
| Facility | | $83.18 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $354.81
| Professional | | $204.17 | $263.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,454.71 / $7,079.46
| Facility | | $794.33 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $218.78 / $467.74
| Professional | | $97.72 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $6,165.95
| Facility | | $56.23 | $1,862.09 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $208.93 / $549.54
| Professional | | $97.72 | $208.93 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,511.89 / $7,079.46
| Facility | | $794.33 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $478.63
| Professional | | $102.33 | $213.80 | $478.63 |