- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.01 / $2,404.58 / $7,069.12
| Facility | | $229.01 | $2,404.58 | $7,069.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.80 / $162.40 / $351.18
| Professional | | $72.80 | $162.40 | $351.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $290.25 / $498.09 / $1,510.37
| Professional | 50 | $290.25 | $498.09 | $1,510.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,759.00 / $3,693.00 / $5,962.00
| Facility | | $1,759.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.72 / $168.34 / $297.72
| Professional | | $90.72 | $168.34 | $297.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $136.08 / $246.83 / $391.40
| Professional | 50 | $136.08 | $246.83 | $391.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.58 / $1,264.58 / $1,514.27
| Facility | | $1,264.58 | $1,264.58 | $1,514.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.54 / $186.94 / $347.66
| Professional | | $97.54 | $186.94 | $347.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.00 / $2,665.00 / $5,510.00
| Facility | | $1,527.00 | $2,665.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.40 / $235.26 / $392.04
| Professional | | $169.40 | $235.26 | $392.04 |