- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $3,388.44 / $10,715.19
| Facility | | $151.36 | $3,388.44 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $602.56 / $4,168.69 / $14,791.08
| Facility | 50 | $602.56 | $4,168.69 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $147.91 / $288.40
| Professional | | $112.20 | $147.91 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $173.78 / $190.55 / $707.95
| Professional | 50 | $173.78 | $190.55 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $302.00
| Professional | | $107.15 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $213.80 / $436.52
| Professional | 50 | $154.88 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $239.88 / $1,000.00
| Facility | | $83.18 | $239.88 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $177.83 / $407.38
| Professional | | $109.65 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $141.25 / $263.03
| Professional | | $102.33 | $141.25 | $263.03 |