- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,623.41 / $9,120.11
| Facility | | $1,318.26 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $11,481.54
| Facility | 50 | $7,762.47 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $4,677.35
| Facility | | $1,047.13 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $1,412.54
| Facility | | $776.25 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $5,370.32
| Professional | | $436.52 | $630.96 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $6,918.31
| Facility | | $1,122.02 | $3,981.07 | $6,918.31 |