- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,655.44 / $8,655.44 / $8,655.44
| Facility | 50 | $8,655.44 | $8,655.44 | $8,655.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.95 / $205.68 / $360.32
| Professional | | $123.95 | $205.68 | $360.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.50 / $302.83 / $427.62
| Professional | | $190.50 | $302.83 | $427.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.97 / $324.74 / $519.22
| Professional | | $191.97 | $324.74 | $519.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.33 / $359.91 / $556.79
| Professional | | $241.33 | $359.91 | $556.79 |