- 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
- $1,778.28 / $1,778.28 / $2,884.03
| Facility | 50 | $1,778.28 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $104.71 / $263.03
| Professional | | $57.54 | $104.71 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $194.98 / $562.34
| Professional | 50 | $109.65 | $194.98 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $389.05 / $645.65
| Facility | | $204.17 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $91.20 / $162.18
| Professional | | $54.95 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $120.23 / $199.53
| Professional | | $72.44 | $120.23 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $102.33 / $190.55
| Professional | | $60.26 | $102.33 | $190.55 |