- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,981.07 / $9,549.93
| Facility | | $851.14 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $8,128.31
| Facility | 50 | $3,311.31 | $6,165.95 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $436.52 / $562.34
| Professional | | $371.54 | $436.52 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $891.25 / $1,071.52
| Professional | | $794.33 | $891.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,230.27
| Facility | | $489.78 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $8,709.64
| Facility | | $478.63 | $794.33 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |