- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $2,691.53 / $8,511.38
| Facility | | $165.96 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.56 / $1,288.25 / $5,754.40
| Facility | 50 | $0.56 | $1,288.25 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $128.82 / $275.42
| Professional | | $75.86 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $346.74 / $691.83
| Professional | 50 | $199.53 | $346.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $141.25 / $288.40
| Professional | | $85.11 | $141.25 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $128.82 / $204.17 / $363.08
| Professional | 50 | $128.82 | $204.17 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $354.81 / $1,000.00
| Facility | | $89.13 | $354.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $165.96 / $331.13
| Professional | | $91.20 | $165.96 | $331.13 |
- 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
- $75.86 / $134.90 / $257.04
| Professional | | $75.86 | $134.90 | $257.04 |