- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,398.83 / $8,128.31
| Facility | | $151.36 | $2,398.83 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $134.90 / $354.81
| Professional | | $70.79 | $134.90 | $354.81 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $8,709.64
| Facility | | $1,412.54 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $109.65 / $223.87
| Professional | | $61.66 | $109.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $93.33 / $162.18 / $323.59
| Professional | 50 | $93.33 | $162.18 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $426.58 / $1,318.26
| Facility | | $123.03 | $426.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $154.88 / $346.74
| Professional | | $79.43 | $154.88 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,949.84 / $4,677.35
| Facility | | $645.65 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $128.82 / $257.04
| Professional | | $66.07 | $128.82 | $257.04 |