- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $3,162.28 / $4,570.88
| Facility | | $186.21 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $138.04 / $407.38
| Professional | | $70.79 | $138.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Professional | 50 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $128.82 / $245.47
| Professional | | $75.86 | $128.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $107.15
| Professional | | $32.36 | $33.11 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $3,630.78
| Facility | | $1,348.96 | $1,584.89 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $338.84
| Professional | | $123.03 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $162.18 / $380.19
| Professional | | $87.10 | $162.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $204.17 / $281.84
| Professional | | $100.00 | $204.17 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $117.49 / $199.53
| Professional | | $67.61 | $117.49 | $199.53 |