- 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
- $125.89 / $251.19 / $758.58
| Professional | | $125.89 | $251.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,047.13 / $1,122.02 / $2,511.89
| Professional | 50 | $1,047.13 | $1,122.02 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $245.47 / $436.52
| Professional | | $120.23 | $245.47 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $269.15 / $575.44
| Professional | | $162.18 | $269.15 | $575.44 |
- 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
- $128.82 / $245.47 / $501.19
| Professional | | $128.82 | $245.47 | $501.19 |