- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.77 / $1,049.02 / $3,706.14
| Facility | | $1,004.77 | $1,049.02 | $3,706.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $979.33 / $979.33 / $979.33
| Facility | 50 | $979.33 | $979.33 | $979.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.55 / $105.43 / $151.12
| Professional | | $99.55 | $105.43 | $151.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.84 / $134.24 / $194.04
| Professional | | $108.84 | $134.24 | $194.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.37 / $133.43 / $231.05
| Professional | | $75.37 | $133.43 | $231.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,417.00 / $4,915.00
| Facility | | $540.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.07 / $159.00 / $240.54
| Professional | | $96.07 | $159.00 | $240.54 |