- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,621.81 / $3,981.07
| Facility | | $1,513.56 | $1,621.81 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $120.23 / $281.84
| Professional | | $56.23 | $120.23 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $389.05 / $416.87
| Professional | 50 | $371.54 | $389.05 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $91.20 / $162.18
| Professional | | $53.70 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $123.03 / $281.84
| Professional | | $72.44 | $123.03 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $107.15 / $239.88
| Professional | | $61.66 | $107.15 | $239.88 |