- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $2,570.40 / $8,511.38
| Facility | | $173.78 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $426.58 / $1,071.52 / $1,737.80
| Facility | 50 | $426.58 | $1,071.52 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $323.59
| Professional | | $104.71 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.36 / $208.93 / $933.25
| Professional | 50 | $151.36 | $208.93 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,912.51
| Facility | | $1,445.44 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $288.40
| Professional | | $100.00 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $144.54 / $213.80 / $416.87
| Professional | 50 | $144.54 | $213.80 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $194.98 / $1,000.00
| Facility | | $70.79 | $194.98 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $169.82 / $398.11
| Professional | | $104.71 | $169.82 | $398.11 |
- 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
- $95.50 / $134.90 / $257.04
| Professional | | $95.50 | $134.90 | $257.04 |