- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,235.94 / $9,120.11
| Facility | | $245.47 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $707.95 / $2,398.83 / $2,570.40
| Facility | 50 | $707.95 | $2,398.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $208.93 / $537.03
| Professional | | $125.89 | $208.93 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $1,584.89 / $1,584.89
| Professional | 50 | $575.44 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $12,302.69
| Facility | | $2,089.30 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $426.58
| Professional | | $128.82 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.55 / $331.13 / $630.96
| Professional | 50 | $190.55 | $331.13 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $346.74 / $1,621.81
| Facility | | $154.88 | $346.74 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $269.15 / $575.44
| Professional | | $151.36 | $269.15 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,148.15 / $3,467.37
| Facility | | $302.00 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $407.38
| Professional | | $125.89 | $213.80 | $407.38 |