- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,630.27 / $8,317.64
| Facility | | $245.47 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $2,630.27 / $7,943.28
| Facility | 50 | $741.31 | $2,630.27 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $229.09 / $501.19
| Professional | | $74.13 | $229.09 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $11,748.98
| Facility | | $2,238.72 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $141.25 / $407.38
| Professional | | $79.43 | $141.25 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $724.44 / $2,290.87
| Facility | | $34.67 | $724.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $245.47 / $645.65
| Professional | | $89.13 | $245.47 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,174.90 / $3,630.78
| Facility | | $295.12 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $229.09 / $512.86
| Professional | | $81.28 | $229.09 | $512.86 |