- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.34 / $2,397.28 / $8,568.00
| Facility | | $74.34 | $2,397.28 | $8,568.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $366.24 / $366.24 / $366.24
| Facility | 50 | $366.24 | $366.24 | $366.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.48 / $80.40 / $140.53
| Professional | | $49.48 | $80.40 | $140.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $73.88 / $129.26 / $156.53
| Professional | 50 | $73.88 | $129.26 | $156.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.45 / $72.54 / $114.49
| Professional | | $55.45 | $72.54 | $114.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $64.12 / $82.22 / $104.67
| Professional | 50 | $64.12 | $82.22 | $104.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.25 / $101.41 / $158.21
| Professional | | $63.25 | $101.41 | $158.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.08 / $88.69 / $146.60
| Facility | | $55.08 | $88.69 | $146.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.09 / $100.14 / $177.37
| Professional | | $65.09 | $100.14 | $177.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,491.00 / $2,720.00
| Facility | | $730.00 | $1,491.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.14 / $132.40 / $228.28
| Professional | | $96.14 | $132.40 | $228.28 |