- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $4,365.16 / $8,511.38
| Facility | | $190.55 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $97.72 / $302.00
| Professional | | $57.54 | $97.72 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $128.82 / $302.00 / $524.81
| Professional | 50 | $128.82 | $302.00 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $120.23 / $181.97
| Professional | | $69.18 | $120.23 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $177.83 / $263.03
| Professional | 50 | $109.65 | $177.83 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $151.36 / $251.19
| Professional | | $85.11 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $144.54 / $204.17
| Professional | | $97.72 | $144.54 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $117.49 / $245.47
| Professional | | $58.88 | $117.49 | $245.47 |