- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $4,691.85
| Facility | | $1,518.41 | $3,706.14 | $4,691.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,773.43 / $9,383.71 / $9,509.36
| Facility | 50 | $4,773.43 | $9,383.71 | $9,509.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.23 / $378.62 / $641.16
| Professional | | $184.23 | $378.62 | $641.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $413.55 / $559.64 / $560.70
| Professional | 50 | $413.55 | $559.64 | $560.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.55 / $410.54 / $697.93
| Professional | | $202.55 | $410.54 | $697.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.18 / $455.99 / $852.23
| Professional | | $283.18 | $455.99 | $852.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.51 / $602.41 / $952.34
| Professional | | $376.51 | $602.41 | $952.34 |