- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $2,774.28 / $3,955.04
| Facility | | $1,518.41 | $2,774.28 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,212.60 / $6,212.60 / $6,212.60
| Facility | 50 | $6,212.60 | $6,212.60 | $6,212.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.43 / $181.67 / $643.37
| Professional | | $101.43 | $181.67 | $643.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.27 / $483.06 / $715.54
| Professional | | $114.27 | $483.06 | $715.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.77 / $229.78 / $1,210.89
| Professional | | $131.77 | $229.78 | $1,210.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.16 / $746.93 / $1,255.11
| Professional | | $514.16 | $746.93 | $1,255.11 |