- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.74 / $1,692.00 / $8,135.01
| Facility | | $128.74 | $1,692.00 | $8,135.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.46 / $330.86 / $600.71
| Professional | | $124.46 | $330.86 | $600.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.71 / $218.85 / $950.11
| Professional | | $145.71 | $218.85 | $950.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.61 / $1,717.92 / $4,467.84
| Facility | | $1,002.61 | $1,717.92 | $4,467.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $975.77 / $975.77 / $975.77
| Facility | 50 | $975.77 | $975.77 | $975.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.23 / $540.32 / $1,230.23
| Professional | | $169.23 | $540.32 | $1,230.23 |