- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $2,344.23 / $8,128.31
| Facility | | $112.20 | $2,344.23 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $2,238.72 / $9,332.54
| Facility | 50 | $446.68 | $2,238.72 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $234.42 / $562.34
| Professional | | $46.77 | $234.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $165.96 / $416.87 / $1,584.89
| Professional | 50 | $165.96 | $416.87 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $13,489.63
| Facility | | $2,630.27 | $5,495.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $275.42 / $645.65
| Professional | | $52.48 | $275.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $77.62 / $416.87 / $933.25
| Professional | 50 | $77.62 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $346.74 / $1,905.46
| Facility | | $51.29 | $346.74 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $213.80 / $630.96
| Professional | | $52.48 | $213.80 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,148.15 / $3,630.78
| Facility | | $288.40 | $1,148.15 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $239.88 / $562.34
| Professional | | $48.98 | $239.88 | $562.34 |