- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,238.72
| Facility | | $758.58 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $194.98 / $323.59
| Professional | | $125.89 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | 50 | $331.13 | $331.13 | $331.13 |
- 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
- $93.33 / $158.49 / $245.47
| Professional | | $93.33 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $204.17 / $416.87
| Professional | | $125.89 | $204.17 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,348.96
| Facility | | $251.19 | $562.34 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $288.40
| Professional | | $107.15 | $173.78 | $288.40 |