- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $3,388.44 / $10,715.19
| Facility | | $109.65 | $3,388.44 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,332.54
| Facility | 50 | $524.81 | $2,818.38 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $109.65 / $199.53
| Professional | | $77.62 | $109.65 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $194.98 / $660.69
| Professional | 50 | $147.91 | $194.98 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $109.65 / $223.87
| Professional | | $75.86 | $109.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $112.20 / $158.49 / $316.23
| Professional | 50 | $112.20 | $158.49 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $309.03 / $870.96
| Facility | | $50.12 | $309.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $131.83 / $281.84
| Professional | | $77.62 | $131.83 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,122.02 / $3,467.37
| Facility | | $263.03 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $107.15 / $190.55
| Professional | | $72.44 | $107.15 | $190.55 |