- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,398.83 / $6,606.93
| Facility | | $501.19 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $125.89 / $204.17
| Professional | | $72.44 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | 50 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $104.71 / $177.83
| Professional | | $75.86 | $104.71 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $158.49 / $239.88
| Professional | | $97.72 | $158.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $177.83 / $2,398.83
| Facility | | $72.44 | $177.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $158.49 / $1,000.00
| Professional | | $112.20 | $158.49 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,318.26 / $2,630.27
| Facility | | $354.81 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $114.82 / $181.97
| Professional | | $69.18 | $114.82 | $181.97 |