- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $2,818.38 / $8,912.51
| Facility | | $208.93 | $2,818.38 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $309.03 / $3,715.35 / $7,943.28
| Facility | 50 | $309.03 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $169.82 / $371.54
| Professional | | $91.20 | $169.82 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $158.49 / $309.03
| Professional | | $91.20 | $158.49 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $295.12 / $1,348.96
| Facility | | $104.71 | $295.12 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $199.53 / $457.09
| Professional | | $97.72 | $199.53 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,041.74 / $5,011.87
| Facility | | $602.56 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $158.49 / $309.03
| Professional | | $87.10 | $158.49 | $309.03 |