- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.22 / $1,100.64 / $1,528.68
| Facility | | $340.22 | $1,100.64 | $1,528.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,458.76 / $3,458.76 / $3,458.76
| Facility | 50 | $3,458.76 | $3,458.76 | $3,458.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.86 / $368.72 / $642.79
| Professional | | $211.86 | $368.72 | $642.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.19 / $285.85 / $427.21
| Professional | | $242.19 | $285.85 | $427.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.28 / $427.39 / $631.39
| Professional | 50 | $363.28 | $427.39 | $631.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.94 / $476.63 / $808.00
| Professional | | $337.94 | $476.63 | $808.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.88 / $452.60 / $704.25
| Professional | | $272.88 | $452.60 | $704.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.85 / $1,100.64 / $1,543.74
| Facility | | $0.85 | $1,100.64 | $1,543.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,458.76 / $3,458.76 / $3,458.76
| Facility | 50 | $3,458.76 | $3,458.76 | $3,458.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.61 / $368.73 / $643.54
| Professional | | $225.61 | $368.73 | $643.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.36 / $535.28 / $701.83
| Professional | | $369.36 | $535.28 | $701.83 |