- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $831.76 / $3,235.94
| Facility | | $131.83 | $831.76 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | 50 | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $316.23
| Professional | | $125.89 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $112.20 / $181.97
| Professional | | $109.65 | $112.20 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $489.78 / $676.08
| Facility | | $416.87 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $630.96 / $741.31 / $1,000.00
| Facility | 50 | $630.96 | $741.31 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $223.87
| Professional | | $131.83 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $263.03
| Professional | | $131.83 | $169.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $229.09
| Professional | | $107.15 | $151.36 | $229.09 |