- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.96 / $332.87 / $5,655.85
| Facility | | $81.96 | $332.87 | $5,655.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $145.91 / $1,710.00 / $4,412.37
| Facility | 50 | $145.91 | $1,710.00 | $4,412.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.20 / $208.60 / $332.87
| Professional | | $71.20 | $208.60 | $332.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.54 / $202.34 / $432.16
| Professional | | $76.54 | $202.34 | $432.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,479.66 / $1,479.66 / $1,479.66
| Facility | 50 | $1,479.66 | $1,479.66 | $1,479.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.26 / $326.41 / $664.58
| Professional | | $210.26 | $326.41 | $664.58 |