- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,818.38 / $8,709.64
| Facility | | $218.78 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $1,513.56 / $8,128.31
| Facility | 50 | $457.09 | $1,513.56 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $331.13
| Professional | | $102.33 | $177.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.44 / $263.03 / $549.54
| Professional | 50 | $72.44 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $162.18 / $309.03
| Professional | | $83.18 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $123.03 / $245.47 / $446.68
| Professional | 50 | $123.03 | $245.47 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $295.12 / $1,412.54
| Facility | | $104.71 | $295.12 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $223.87 / $489.78
| Professional | | $117.49 | $223.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $346.74
| Professional | | $100.00 | $173.78 | $346.74 |