- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $234.42 / $575.44
| Professional | | $128.82 | $234.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | 50 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $1,122.02
| Professional | | $524.81 | $851.14 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $436.52 / $776.25 / $1,698.24
| Professional | 50 | $436.52 | $776.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $288.40 / $436.52
| Professional | | $199.53 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,630.27 / $10,471.29
| Facility | | $1,995.26 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $724.44
| Professional | | $234.42 | $380.19 | $724.44 |