- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $3,630.78 / $7,079.46
| Facility | | $109.65 | $3,630.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $81.28 / $239.88
| Professional | | $28.18 | $81.28 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $77.62
| Professional | | $32.36 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $47.86 / $69.18 / $109.65
| Professional | 50 | $47.86 | $69.18 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $70.79 / $144.54
| Professional | | $42.66 | $70.79 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $60.26 / $60.26
| Professional | | $57.54 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $48.98 / $93.33
| Professional | | $29.51 | $48.98 | $93.33 |