- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.37 / $1,354.65 / $3,781.63
| Facility | | $106.37 | $1,354.65 | $3,781.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,327.27 / $2,635.63 / $4,451.13
| Facility | 50 | $1,327.27 | $2,635.63 | $4,451.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.04 / $175.65 / $297.29
| Professional | | $98.04 | $175.65 | $297.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $807.68 / $807.68 / $1,104.30
| Professional | 50 | $807.68 | $807.68 | $1,104.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.77 / $289.62 / $479.96
| Professional | | $207.77 | $289.62 | $479.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $311.66 / $425.07 / $719.94
| Professional | 50 | $311.66 | $425.07 | $719.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.88 / $323.85 / $512.23
| Professional | | $173.88 | $323.85 | $512.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.37 / $192.26 / $386.49
| Facility | | $106.37 | $192.26 | $386.49 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,092.51 / $2,408.42 / $3,230.71
| Facility | 50 | $2,092.51 | $2,408.42 | $3,230.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.34 / $355.65 / $1,012.00
| Professional | | $208.34 | $355.65 | $1,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.61 / $346.23 / $430.34
| Professional | | $195.61 | $346.23 | $430.34 |