- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,344.23 / $7,413.10
| Facility | | $549.54 | $2,344.23 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $1,621.81 / $31,622.78
| Facility | 50 | $524.81 | $1,621.81 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $186.21 / $467.74 / $977.24
| Professional | 50 | $186.21 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $316.23 / $794.33
| Professional | 50 | $154.88 | $316.23 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $245.47 / $407.38 / $724.44
| Professional | 50 | $245.47 | $407.38 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $154.88 / $165.96
| Facility | | $151.36 | $154.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $309.03 / $1,949.84
| Professional | | $128.82 | $309.03 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,513.56 / $2,511.89
| Facility | | $288.40 | $1,513.56 | $2,511.89 |