- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $3,801.89
| Facility | | $1,258.93 | $1,445.44 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $741.31
| Professional | | $234.42 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $549.54 / $1,071.52
| Professional | 50 | $354.81 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $524.81
| Professional | | $213.80 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $426.58 / $741.31
| Professional | | $186.21 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $8,912.51
| Facility | | $2,570.40 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $794.33
| Professional | | $251.19 | $416.87 | $794.33 |