- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $2,630.27 / $3,548.13
| Facility | | $169.82 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,630.27 / $4,365.16 / $8,317.64
| Facility | 50 | $2,630.27 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $407.38
| Professional | | $147.91 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $346.74 / $537.03
| Professional | 50 | $162.18 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $204.17 / $288.40
| Professional | | $147.91 | $204.17 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $11,481.54
| Facility | | $5,495.41 | $5,495.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,041.74 / $4,073.80 / $5,888.44
| Facility | 50 | $2,041.74 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $288.40
| Professional | | $144.54 | $181.97 | $288.40 |