- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $173.78 / $2,511.89
| Facility | | $85.11 | $173.78 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,445.44 / $1,513.56 / $4,786.30
| Facility | 50 | $1,445.44 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $186.21 / $426.58
| Professional | | $85.11 | $186.21 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $123.03 / $338.84 / $812.83
| Professional | 50 | $123.03 | $338.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $162.18 / $316.23
| Professional | | $81.28 | $162.18 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,511.89 / $2,951.21
| Facility | | $2,344.23 | $2,511.89 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 50 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Professional | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | 50 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $5,011.87
| Facility | | $436.52 | $436.52 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $154.88 / $338.84
| Professional | | $75.86 | $154.88 | $338.84 |