- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,548.82 / $7,585.78
| Facility | | $234.42 | $1,548.82 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $891.25 / $2,041.74
| Professional | | $144.54 | $891.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $223.87 / $794.33 / $5,495.41
| Professional | 50 | $223.87 | $794.33 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,412.54 / $2,818.38
| Professional | | $204.17 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $870.96 / $2,041.74
| Professional | | $186.21 | $870.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $707.95 / $1,380.38
| Facility | | $144.54 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $1,995.26
| Professional | | $389.05 | $389.05 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,890.45 / $6,760.83
| Facility | | $1,318.26 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $724.44 / $1,905.46
| Professional | | $147.91 | $724.44 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,466.84 / $4,466.84
| Facility | | $56.23 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $7,585.78
| Professional | | $6,456.54 | $7,585.78 | $7,585.78 |