- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.06 / $891.42 / $1,867.51
| Facility | | $143.06 | $891.42 | $1,867.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,188.55 / $1,188.55 / $2,200.28
| Facility | 50 | $1,188.55 | $1,188.55 | $2,200.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.33 / $143.07 / $242.26
| Professional | | $129.33 | $143.07 | $242.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.41 / $198.19 / $291.85
| Professional | | $164.41 | $198.19 | $291.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.00 / $223.55 / $331.57
| Professional | | $184.00 | $223.55 | $331.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.97 / $218.90 / $335.81
| Professional | | $169.97 | $218.90 | $335.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.42 / $1,867.51 / $6,590.90
| Facility | | $891.42 | $1,867.51 | $6,590.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,188.55 / $1,188.55 / $2,200.28
| Facility | 50 | $1,188.55 | $1,188.55 | $2,200.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.06 / $143.07 / $286.02
| Professional | | $143.06 | $143.07 | $286.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.19 / $223.74 / $307.94
| Professional | | $151.19 | $223.74 | $307.94 |