- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $138.04 / $309.03
| Professional | | $52.48 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $501.19 / $501.19
| Professional | 50 | $457.09 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $102.33 / $181.97
| Professional | | $50.12 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $141.25 / $234.42
| Professional | | $67.61 | $141.25 | $234.42 |
- 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
- $57.54 / $117.49 / $239.88
| Professional | | $57.54 | $117.49 | $239.88 |