- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,187.76 / $8,511.38
| Facility | | $229.09 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $549.54 / $912.01
| Professional | 50 | $199.53 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $147.91 / $363.08
| Professional | 50 | $147.91 | $147.91 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $14,454.40 / $28,183.83
| Facility | | $11,220.18 | $14,454.40 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $331.13 / $549.54
| Facility | | $144.54 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $707.95
| Professional | | $263.03 | $436.52 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,548.82 / $4,570.88
| Facility | | $288.40 | $1,548.82 | $4,570.88 |