- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $2,511.89 / $8,511.38
| Facility | | $199.53 | $2,511.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $1,000.00 / $2,884.03
| Facility | 50 | $295.12 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $489.78
| Professional | | $114.82 | $177.83 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $281.84 / $851.14
| Professional | 50 | $162.18 | $281.84 | $851.14 |
- 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
- $100.00 / $154.88 / $295.12
| Professional | | $100.00 | $154.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.36 / $229.09 / $426.58
| Professional | 50 | $151.36 | $229.09 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $398.11 / $1,096.48
| Facility | | $50.12 | $398.11 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $416.87
| Professional | | $112.20 | $186.21 | $416.87 |
- 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 / $147.91 / $275.42
| Professional | | $102.33 | $147.91 | $275.42 |