- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,551.49 / $5,930.83 / $9,768.44
| Facility | | $3,551.49 | $5,930.83 | $9,768.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,610.23 / $7,053.79 / $15,060.55
| Facility | 50 | $3,610.23 | $7,053.79 | $15,060.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.00 / $1,335.00 / $3,314.62
| Facility | | $1,335.00 | $1,335.00 | $3,314.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.19 / $1,270.25 / $1,668.57
| Professional | | $975.19 | $1,270.25 | $1,668.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.00 / $1,003.00 / $2,156.00
| Facility | | $1,003.00 | $1,003.00 | $2,156.00 |