- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.83 / $3,361.74 / $3,361.74
| Facility | | $296.83 | $3,361.74 | $3,361.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.83 / $780.30 / $2,056.40
| Professional | | $296.83 | $780.30 | $2,056.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $248.74 / $248.74 / $248.74
| Professional | 50 | $248.74 | $248.74 | $248.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.70 / $812.59 / $3,445.51
| Professional | | $572.70 | $812.59 | $3,445.51 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $859.05 / $2,575.53 / $5,151.05
| Professional | 50 | $859.05 | $2,575.53 | $5,151.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.98 / $500.98 / $500.98
| Facility | | $500.98 | $500.98 | $500.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.81 / $974.64 / $3,633.02
| Professional | | $356.81 | $974.64 | $3,633.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.64 / $758.84 / $3,346.53
| Facility | | $372.64 | $758.84 | $3,346.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.14 / $3,326.37 / $11,617.10
| Professional | | $1,482.14 | $3,326.37 | $11,617.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $696.83 / $696.83 / $696.83
| Professional | 50 | $696.83 | $696.83 | $696.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.15 / $2,827.33 / $4,063.51
| Professional | | $1,560.15 | $2,827.33 | $4,063.51 |