- 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
- $33.11 / $63.10 / $141.25
| Professional | | $33.11 | $63.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $64.57 / $169.82 / $363.08
| Professional | 50 | $64.57 | $169.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $46.77 / $81.28
| Professional | | $30.90 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $67.61 / $97.72
| Professional | | $40.74 | $67.61 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $54.95 / $91.20
| Professional | | $36.31 | $54.95 | $91.20 |