- 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 / $131.83 / $309.03
| Professional | | $52.48 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $234.42 / $281.84
| Professional | 50 | $234.42 | $234.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $91.20 / $162.18
| Professional | | $51.29 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $123.03 / $251.19
| Professional | | $67.61 | $123.03 | $251.19 |
- 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 / $112.20 / $218.78
| Professional | | $57.54 | $112.20 | $218.78 |