- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.76 / $435.16 / $3,140.00
| Facility | | $56.76 | $435.16 | $3,140.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $960.48 / $2,401.69 / $3,530.58
| Facility | 50 | $960.48 | $2,401.69 | $3,530.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.85 / $93.17 / $157.05
| Professional | | $53.85 | $93.17 | $157.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.23 / $142.66 / $168.58
| Professional | | $51.23 | $142.66 | $168.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.45 / $980.64 / $4,110.70
| Facility | | $189.45 | $980.64 | $4,110.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,979.29 / $2,979.29 / $2,979.29
| Facility | 50 | $2,979.29 | $2,979.29 | $2,979.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.89 / $138.13 / $324.70
| Professional | | $98.89 | $138.13 | $324.70 |