- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $5,888.44 / $14,125.38
| Facility | | $363.08 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $229.09 / $602.56
| Professional | | $114.82 | $229.09 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,071.52
| Professional | | $302.00 | $501.19 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $331.13 / $1,122.02
| Facility | | $147.91 | $331.13 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $588.84 / $1,230.27
| Professional | | $269.15 | $588.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $616.60 / $1,071.52
| Professional | | $346.74 | $616.60 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $309.03 / $831.76
| Facility | | $141.25 | $309.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $181.97 / $602.56
| Professional | | $60.26 | $181.97 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $616.60 / $1,412.54
| Professional | | $234.42 | $616.60 | $1,412.54 |