- 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
- $117.49 / $147.91 / $371.54
| Professional | | $117.49 | $147.91 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $263.03 / $891.25
| Professional | 50 | $263.03 | $263.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $120.23 / $204.17
| Professional | | $89.13 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $138.04 / $245.47
| Professional | | $93.33 | $138.04 | $245.47 |
- 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
- $83.18 / $131.83 / $199.53
| Professional | | $83.18 | $131.83 | $199.53 |