- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $436.52 / $8,128.31
| Facility | | $158.49 | $436.52 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,630.27 / $4,466.84 / $8,128.31
| Facility | 50 | $2,630.27 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $426.58 / $812.83
| Professional | | $173.78 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $46.77 / $562.34 / $933.25
| Professional | 50 | $46.77 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $398.11 / $645.65
| Professional | | $177.83 | $398.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $977.24 / $4,265.80 / $11,748.98
| Facility | 50 | $977.24 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $380.19 / $616.60
| Professional | | $177.83 | $380.19 | $616.60 |