- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $5,011.87 / $11,748.98
| Facility | | $380.19 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $2,818.38
| Facility | 50 | $1,258.93 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $954.99
| Professional | | $269.15 | $371.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $501.19 / $645.65
| Professional | 50 | $251.19 | $501.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $524.81
| Professional | | $186.21 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Professional | 50 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,128.61 / $10,232.93
| Facility | | $2,089.30 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $363.08 / $512.86
| Professional | | $251.19 | $363.08 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $338.84
| Facility | | $263.03 | $263.03 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $741.31
| Professional | | $316.23 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $436.52 / $831.76
| Facility | | $281.84 | $436.52 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $10,964.78 / $16,982.44
| Facility | | $2,754.23 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $676.08
| Professional | | $275.42 | $389.05 | $676.08 |