- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.43 / $8,364.70 / $9,807.29
| Facility | | $310.43 | $8,364.70 | $9,807.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.15 / $312.68 / $479.41
| Professional | | $210.15 | $312.68 | $479.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.24 / $370.77 / $490.60
| Professional | | $251.24 | $370.77 | $490.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $376.86 / $566.77 / $735.91
| Professional | 50 | $376.86 | $566.77 | $735.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.09 / $422.67 / $691.66
| Professional | | $252.09 | $422.67 | $691.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.88 / $339.57 / $498.95
| Professional | | $225.88 | $339.57 | $498.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,046.74 / $8,563.62 / $9,912.71
| Facility | | $5,046.74 | $8,563.62 | $9,912.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.86 / $336.50 / $493.09
| Professional | | $222.86 | $336.50 | $493.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,240.48 / $3,240.48 / $3,240.48
| Facility | | $3,240.48 | $3,240.48 | $3,240.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.61 / $446.91 / $623.22
| Professional | | $312.61 | $446.91 | $623.22 |