- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $954.99 / $4,168.69
| Facility | | $134.90 | $954.99 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $3,981.07
| Facility | 50 | $2,511.89 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $102.33 / $275.42
| Professional | | $47.86 | $102.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $562.34 / $2,041.74
| Professional | | $56.23 | $562.34 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $97.72 / $213.80
| Professional | | $53.70 | $97.72 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $165.96 / $302.00
| Professional | | $138.04 | $165.96 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $2,290.87
| Facility | | $213.80 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $91.20 / $181.97
| Professional | | $48.98 | $91.20 | $181.97 |