- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $5,370.32
| Facility | 50 | $2,754.23 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $194.98 / $416.87
| Professional | | $102.33 | $194.98 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $269.15 / $457.09 / $1,148.15
| Professional | 50 | $269.15 | $457.09 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $316.23
| Professional | | $97.72 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $398.11
| Professional | | $128.82 | $223.87 | $398.11 |
- 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
- $102.33 / $194.98 / $426.58
| Professional | | $102.33 | $194.98 | $426.58 |