- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.90 / $5,151.04 / $6,902.42
| Facility | | $1,072.90 | $5,151.04 | $6,902.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,656.88 / $7,656.88 / $7,656.88
| Facility | 50 | $7,656.88 | $7,656.88 | $7,656.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.21 / $715.00 / $4,493.43
| Facility | | $641.21 | $715.00 | $4,493.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.65 / $1,023.81 / $1,513.08
| Professional | | $793.65 | $1,023.81 | $1,513.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.00 / $1,003.00 / $2,156.00
| Facility | | $1,003.00 | $1,003.00 | $2,156.00 |