- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.16 / $902.23 / $5,503.00
| Facility | | $160.16 | $902.23 | $5,503.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.89 / $135.53 / $226.44
| Professional | | $46.89 | $135.53 | $226.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.69 / $72.72 / $114.97
| Professional | | $54.69 | $72.72 | $114.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $74.16 / $86.65 / $172.46
| Professional | 50 | $74.16 | $86.65 | $172.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.75 / $146.94 / $299.48
| Professional | | $60.75 | $146.94 | $299.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.25 / $152.19 / $266.00
| Facility | | $55.25 | $152.19 | $266.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.03 / $181.84 / $309.23
| Professional | | $67.03 | $181.84 | $309.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,491.00 / $3,011.00
| Facility | | $730.00 | $1,491.00 | $3,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.99 / $251.18 / $392.48
| Professional | | $156.99 | $251.18 | $392.48 |