- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,801.89 / $8,511.38
| Facility | | $537.03 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,548.13
| Facility | 50 | $3,235.94 | $3,235.94 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $630.96
| Professional | | $257.04 | $371.54 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $707.95 / $724.44 / $724.44
| Professional | 50 | $707.95 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $263.03 / $316.23
| Professional | | $218.78 | $263.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Professional | 50 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $5,623.41
| Facility | | $2,691.53 | $3,548.13 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $478.63
| Professional | | $363.08 | $363.08 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $426.58 / $707.95
| Professional | | $281.84 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $501.19 / $3,630.78
| Facility | | $181.97 | $501.19 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $2,884.03
| Professional | | $380.19 | $501.19 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,089.30 / $4,677.35
| Facility | | $1,122.02 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $588.84
| Professional | | $295.12 | $407.38 | $588.84 |