- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,398.83 / $7,762.47
| Facility | | $218.78 | $2,398.83 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $912.01 / $3,467.37 / $7,413.10
| Facility | 50 | $912.01 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $194.98 / $478.63
| Professional | | $77.62 | $194.98 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $257.04 / $1,096.48
| Professional | 50 | $141.25 | $257.04 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $8,709.64
| Facility | | $1,412.54 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $128.82 / $281.84
| Professional | | $69.18 | $128.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $104.71 / $194.98 / $407.38
| Professional | 50 | $104.71 | $194.98 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $537.03 / $1,737.80
| Facility | | $134.90 | $537.03 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $208.93 / $512.86
| Professional | | $87.10 | $208.93 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $173.78 / $371.54
| Professional | | $74.13 | $173.78 | $371.54 |