- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $2,344.23 / $8,128.31
| Facility | | $131.83 | $2,344.23 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $2,041.74 / $6,456.54
| Facility | 50 | $524.81 | $2,041.74 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $123.03 / $363.08
| Professional | | $58.88 | $123.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $144.54 / $630.96
| Professional | 50 | $141.25 | $144.54 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,715.35 / $10,000.00
| Facility | | $1,412.54 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $97.72 / $204.17
| Professional | | $58.88 | $97.72 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $89.13 / $147.91 / $302.00
| Professional | 50 | $89.13 | $147.91 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $436.52 / $1,318.26
| Facility | | $104.71 | $436.52 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $141.25 / $316.23
| Professional | | $70.79 | $141.25 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,174.90 / $3,630.78
| Facility | | $269.15 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $117.49 / $234.42
| Professional | | $60.26 | $117.49 | $234.42 |