- 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
- $239.88 / $562.34 / $1,778.28
| Professional | | $239.88 | $562.34 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Professional | 50 | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $851.14
| Professional | | $162.18 | $213.80 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $380.19 / $1,047.13
| Professional | | $181.97 | $380.19 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,454.71 / $6,025.60
| Facility | | $1,348.96 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $831.76
| Professional | | $354.81 | $524.81 | $831.76 |