- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,818.38 / $8,912.51
| Facility | | $269.15 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $2,290.87 / $2,754.23
| Facility | 50 | $1,148.15 | $2,290.87 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $426.58
| Professional | | $138.04 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $281.84 / $1,122.02
| Professional | 50 | $251.19 | $281.84 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $208.93 / $398.11
| Professional | | $123.03 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $186.21 / $309.03 / $562.34
| Professional | 50 | $186.21 | $309.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $588.84 / $1,995.26
| Facility | | $50.12 | $588.84 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $251.19 / $588.84
| Professional | | $141.25 | $251.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $380.19
| Professional | | $128.82 | $204.17 | $380.19 |