- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $1,202.26 / $6,309.57
| Facility | | $85.11 | $1,202.26 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $660.69 / $1,778.28 / $6,025.60
| Facility | 50 | $660.69 | $1,778.28 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $64.57 / $169.82
| Professional | | $30.20 | $64.57 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $61.66 / $158.49
| Professional | | $33.88 | $61.66 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $213.80 / $630.96
| Facility | | $34.67 | $213.80 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $69.18 / $194.98
| Professional | | $35.48 | $69.18 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,096.48 / $3,467.37
| Facility | | $288.40 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $61.66 / $144.54
| Professional | | $33.11 | $61.66 | $144.54 |