- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,318.26 / $1,862.09
| Facility | | $489.78 | $1,318.26 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $295.12
| Professional | | $109.65 | $173.78 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,041.74
| Facility | | $1,258.93 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,019.95
| Facility | 50 | $1,905.46 | $2,238.72 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $125.89 / $208.93
| Professional | | $75.86 | $125.89 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $169.82 / $338.84
| Professional | | $102.33 | $169.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $147.91 / $234.42
| Professional | | $87.10 | $147.91 | $234.42 |