- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $3,311.31 / $5,754.40
| Facility | | $138.04 | $3,311.31 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $97.72 / $346.74
| Professional | | $58.88 | $97.72 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $128.82 / $162.18 / $524.81
| Professional | 50 | $128.82 | $162.18 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $102.33 / $169.82
| Professional | | $66.07 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $117.49
| Professional | | $32.36 | $33.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $162.18 / $257.04
| Professional | | $97.72 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $109.65 / $204.17
| Professional | | $67.61 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $141.25 / $190.55
| Professional | | $83.18 | $141.25 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $89.13 / $141.25
| Professional | | $56.23 | $89.13 | $141.25 |