- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,981.07 / $6,760.83
| Facility | | $1,230.27 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $6,760.83
| Facility | 50 | $3,715.35 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $2,137.96
| Professional | | $524.81 | $707.95 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $3,235.94 / $9,549.93
| Professional | | $562.34 | $3,235.94 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,862.09
| Professional | | $549.54 | $707.95 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,348.96 / $1,513.56
| Professional | | $660.69 | $1,348.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $16,218.10 / $26,302.68
| Facility | | $2,344.23 | $16,218.10 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $1,659.59
| Professional | | $489.78 | $831.76 | $1,659.59 |