- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,885.82 / $2,885.82 / $2,885.82
| Facility | 50 | $2,885.82 | $2,885.82 | $2,885.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.35 / $220.11 / $313.67
| Professional | | $149.35 | $220.11 | $313.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.02 / $308.23 / $327.58
| Professional | | $186.02 | $308.23 | $327.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.90 / $276.95 / $571.87
| Professional | | $130.90 | $276.95 | $571.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.00 / $4,049.00 / $5,510.00
| Facility | | $1,806.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.32 / $300.16 / $430.76
| Professional | | $188.32 | $300.16 | $430.76 |