- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,862.09 / $4,073.80
| Facility | | $199.53 | $1,862.09 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Facility | 50 | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $257.04 / $2,238.72
| Professional | | $107.15 | $257.04 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $588.84 / $5,754.40
| Professional | 50 | $154.88 | $588.84 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $257.04 / $2,454.71
| Professional | | $114.82 | $257.04 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $229.09 / $457.09
| Professional | | $100.00 | $229.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $234.42 / $446.68
| Professional | | $223.87 | $234.42 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,737.80 / $5,128.61
| Facility | | $741.31 | $1,737.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $208.93 / $478.63
| Professional | | $97.72 | $208.93 | $478.63 |