- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $3,630.78 / $10,232.93
| Facility | | $218.78 | $3,630.78 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $602.56 / $2,187.76 / $7,762.47
| Facility | 50 | $602.56 | $2,187.76 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $512.86
| Professional | | $112.20 | $190.55 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $501.19 / $1,513.56
| Professional | 50 | $263.03 | $501.19 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,630.78 / $9,120.11
| Facility | | $1,513.56 | $3,630.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $380.19
| Professional | | $112.20 | $190.55 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $165.96 / $275.42 / $549.54
| Professional | 50 | $165.96 | $275.42 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $416.87 / $1,659.59
| Facility | | $147.91 | $416.87 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $512.86
| Professional | | $131.83 | $234.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,071.52 / $3,467.37
| Facility | | $213.80 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $190.55 / $363.08
| Professional | | $109.65 | $190.55 | $363.08 |