- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,737.80 / $7,413.10
| Facility | | $158.49 | $1,737.80 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $269.15 / $575.44 / $3,235.94
| Facility | 50 | $269.15 | $575.44 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $204.17 / $512.86
| Professional | | $75.86 | $204.17 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $354.81 / $691.83
| Professional | 50 | $75.86 | $354.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $131.83 / $302.00
| Professional | | $77.62 | $131.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $112.20 / $194.98 / $446.68
| Professional | 50 | $112.20 | $194.98 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $794.33 / $2,187.76
| Facility | | $128.82 | $794.33 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $223.87 / $575.44
| Professional | | $91.20 | $223.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,071.52 / $3,467.37
| Facility | | $199.53 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $181.97 / $407.38
| Professional | | $75.86 | $181.97 | $407.38 |