- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.27 / $1,572.60 / $6,884.85
| Facility | | $1,014.27 | $1,572.60 | $6,884.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,351.55 / $7,351.55 / $7,351.55
| Facility | 50 | $7,351.55 | $7,351.55 | $7,351.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.61 / $536.77 / $611.91
| Professional | | $364.61 | $536.77 | $611.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,144.16 / $1,144.16 / $1,144.16
| Professional | 50 | $1,144.16 | $1,144.16 | $1,144.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.43 / $651.71 / $1,083.84
| Professional | | $300.43 | $651.71 | $1,083.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.22 / $541.22 / $571.00
| Professional | | $541.22 | $541.22 | $571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.77 / $634.24 / $1,321.47
| Professional | | $515.77 | $634.24 | $1,321.47 |