- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,238.72
| Facility | | $758.58 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $275.42 / $457.09
| Professional | | $151.36 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Professional | 50 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,162.28 / $4,265.80
| Facility | | $2,691.53 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,981.07 / $4,786.30 / $6,456.54
| Facility | 50 | $3,981.07 | $4,786.30 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $194.98 / $331.13
| Professional | | $104.71 | $194.98 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $263.03 / $398.11
| Professional | | $144.54 | $263.03 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,698.24 / $3,090.30
| Facility | | $645.65 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $223.87 / $363.08
| Professional | | $120.23 | $223.87 | $363.08 |