- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,380.38 / $7,762.47
| Facility | | $223.87 | $1,380.38 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $10,715.19 / $22,387.21
| Facility | 50 | $501.19 | $10,715.19 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $380.19 / $1,122.02
| Professional | 50 | $147.91 | $380.19 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $134.90 / $147.91 / $281.84
| Professional | 50 | $134.90 | $147.91 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,445.44 / $2,754.23
| Facility | | $537.03 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $446.68 / $1,584.89
| Professional | | $181.97 | $446.68 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $831.76 / $2,630.27
| Facility | | $151.36 | $831.76 | $2,630.27 |