- 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
- $2,064.83 / $2,064.83 / $2,064.83
| Facility | 50 | $2,064.83 | $2,064.83 | $2,064.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.47 / $171.47 / $180.13
| Professional | | $123.47 | $171.47 | $180.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.55 / $188.88 / $314.81
| Professional | | $160.55 | $188.88 | $314.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.85 / $253.81 / $372.14
| Professional | | $121.85 | $253.81 | $372.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.82 / $224.08 / $345.00
| Professional | | $142.82 | $224.08 | $345.00 |