- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $2,089.30 / $7,585.78
| Facility | | $109.65 | $2,089.30 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $2,238.72 / $5,888.44
| Facility | 50 | $446.68 | $2,238.72 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $102.33 / $257.04
| Professional | | $57.54 | $102.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $79.43 / $371.54 / $524.81
| Professional | 50 | $79.43 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $91.20 / $181.97
| Professional | | $57.54 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $87.10 / $138.04 / $269.15
| Professional | 50 | $87.10 | $138.04 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $309.03 / $870.96
| Facility | | $100.00 | $309.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $128.82 / $281.84
| Professional | | $67.61 | $128.82 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $102.33 / $223.87
| Professional | | $57.54 | $102.33 | $223.87 |