- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $2,187.76 / $8,317.64
| Facility | | $181.97 | $2,187.76 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $1,096.48 / $4,265.80
| Facility | 50 | $371.54 | $1,096.48 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $169.82 / $478.63
| Professional | | $114.82 | $169.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.55 / $436.52 / $977.24
| Professional | 50 | $190.55 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,630.78 / $8,709.64
| Facility | | $1,479.11 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $169.82 / $323.59
| Professional | | $114.82 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $165.96 / $239.88 / $467.74
| Professional | 50 | $165.96 | $239.88 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $380.19 / $1,000.00
| Facility | | $79.43 | $380.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $194.98 / $398.11
| Professional | | $125.89 | $194.98 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,071.52 / $3,467.37
| Facility | | $234.42 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $162.18 / $288.40
| Professional | | $104.71 | $162.18 | $288.40 |