- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $1,621.81 / $2,511.89
| Facility | | $190.55 | $1,621.81 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 50 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $208.93
| Professional | | $131.83 | $151.36 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,981.07
| Facility | | $2,884.03 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $194.98
| Professional | | $147.91 | $147.91 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $275.42
| Professional | | $165.96 | $223.87 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,445.44 / $5,248.07
| Facility | | $588.84 | $1,445.44 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $154.88 / $288.40
| Professional | | $123.03 | $154.88 | $288.40 |