- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.38 / $1,413.55 / $4,048.90
| Facility | | $619.38 | $1,413.55 | $4,048.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,219.63 / $2,219.63 / $2,219.63
| Facility | 50 | $2,219.63 | $2,219.63 | $2,219.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.68 / $53.45 / $76.38
| Professional | | $33.68 | $53.45 | $76.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.89 / $55.74 / $95.16
| Professional | | $36.89 | $55.74 | $95.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.16 / $77.12 / $103.03
| Professional | | $52.16 | $77.12 | $103.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.86 / $74.15 / $113.41
| Professional | | $46.86 | $74.15 | $113.41 |