- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $354.81 / $5,888.44
| Facility | | $87.10 | $354.81 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | 50 | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $190.55 / $436.52
| Professional | | $64.57 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $93.33 / $251.19 / $630.96
| Professional | 50 | $93.33 | $251.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $147.91
| Professional | | $74.13 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $102.33 / $151.36 / $245.47
| Professional | 50 | $102.33 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $199.53 / $446.68
| Professional | | $81.28 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $346.74 / $1,047.13
| Professional | | $81.28 | $346.74 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $223.87 / $245.47
| Professional | | $57.54 | $223.87 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,479.11 / $2,691.53
| Facility | | $676.08 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $194.98 / $407.38
| Professional | | $74.13 | $194.98 | $407.38 |