- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $2,344.23 / $7,943.28
| Facility | | $144.54 | $2,344.23 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $141.25 / $316.23
| Professional | | $37.15 | $141.25 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | 50 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $11,220.18
| Facility | | $2,238.72 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $67.61 / $239.88
| Professional | | $34.67 | $67.61 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $47.86 / $95.50 / $302.00
| Professional | 50 | $47.86 | $95.50 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $181.97 / $1,380.38
| Facility | | $41.69 | $181.97 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $154.88 / $363.08
| Professional | | $45.71 | $154.88 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,174.90 / $3,630.78
| Facility | | $245.47 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $128.82 / $281.84
| Professional | | $40.74 | $128.82 | $281.84 |