- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,288.25 / $1,698.24
| Facility | | $288.40 | $1,288.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $1,621.81 / $3,388.44
| Facility | 50 | $309.03 | $1,621.81 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $177.83 / $346.74
| Professional | | $89.13 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $295.12 / $575.44
| Professional | 50 | $138.04 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $138.04 / $213.80
| Professional | | $81.28 | $138.04 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $123.03 / $204.17 / $288.40
| Professional | 50 | $123.03 | $204.17 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $208.93 / $363.08
| Professional | | $112.20 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $234.42 / $380.19
| Professional | | $100.00 | $234.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,288.25 / $1,737.80
| Facility | | $288.40 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $1,621.81 / $3,981.07
| Facility | 50 | $309.03 | $1,621.81 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $186.21 / $371.54
| Professional | | $93.33 | $186.21 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $144.54 / $371.54 / $616.60
| Professional | 50 | $144.54 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $165.96 / $331.13
| Professional | | $89.13 | $165.96 | $331.13 |