- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $3,388.44 / $6,025.60
| Facility | | $123.03 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $239.88 / $5,495.41 / $5,495.41
| Facility | 50 | $239.88 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $89.13 / $309.03
| Professional | | $48.98 | $89.13 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $74.13 / $173.78 / $436.52
| Professional | 50 | $74.13 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $89.13 / $151.36
| Professional | | $56.23 | $89.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $102.33
| Professional | | $32.36 | $33.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $147.91 / $234.42
| Professional | | $83.18 | $147.91 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $100.00 / $190.55
| Professional | | $58.88 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $131.83 / $177.83
| Professional | | $70.79 | $131.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $81.28 / $131.83
| Professional | | $46.77 | $81.28 | $131.83 |