- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $3,090.30 / $10,471.29
| Facility | | $42.66 | $3,090.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $46.77 / $97.72
| Professional | | $26.92 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $53.70 / $56.23 / $77.62
| Professional | 50 | $53.70 | $56.23 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $39.81 / $3,630.78
| Facility | | $29.51 | $39.81 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $52.48 / $104.71
| Professional | | $27.54 | $52.48 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $165.96 / $457.09
| Facility | | $51.29 | $165.96 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $46.77 / $72.44
| Professional | | $43.65 | $46.77 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $51.29 / $95.50
| Professional | | $30.90 | $51.29 | $95.50 |