- 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
- $141.25 / $213.80 / $501.19
| Professional | | $141.25 | $213.80 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $302.00 / $302.00 / $338.84
| Professional | 50 | $302.00 | $302.00 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $323.59
| Professional | | $107.15 | $144.54 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $199.53 / $295.12
| Professional | | $104.71 | $199.53 | $295.12 |
- 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
- $114.82 / $186.21 / $269.15
| Professional | | $114.82 | $186.21 | $269.15 |