- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,479.11 / $8,317.64
| Facility | | $213.80 | $1,479.11 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $269.15 / $3,890.45 / $15,135.61
| Facility | 50 | $269.15 | $3,890.45 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $123.03 / $338.84 / $1,023.29
| Professional | 50 | $123.03 | $338.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $169.82 / $338.84 / $537.03
| Professional | 50 | $169.82 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $398.11 / $1,258.93
| Professional | | $151.36 | $398.11 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,479.11 / $2,691.53
| Facility | | $676.08 | $1,479.11 | $2,691.53 |