- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $2,290.87 / $2,454.71
| Facility | | $33.11 | $2,290.87 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 50 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $275.42 / $776.25
| Professional | | $109.65 | $275.42 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $177.83 / $457.09 / $1,621.81
| Professional | 50 | $177.83 | $457.09 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $36.31 / $36.31 / $37.15
| Professional | 53 | $36.31 | $36.31 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $407.38
| Professional | | $102.33 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $616.60
| Professional | | $138.04 | $229.09 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $223.87 / $501.19
| Professional | | $109.65 | $223.87 | $501.19 |