- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,677.35 / $10,471.29
| Facility | | $912.01 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $45.71 / $112.20
| Professional | | $26.30 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $53.70 / $53.70 / $56.23
| Professional | 50 | $53.70 | $53.70 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $74.13 / $125.89
| Professional | | $46.77 | $74.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $60.26 / $120.23
| Professional | | $34.67 | $60.26 | $120.23 |