- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,401.69 / $4,488.75 / $6,907.00
| Facility | | $2,401.69 | $4,488.75 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,443.81 / $1,443.81 / $1,681.22
| Facility | 50 | $1,443.81 | $1,443.81 | $1,681.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.33 / $139.66 / $163.58
| Professional | | $129.33 | $139.66 | $163.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.55 / $188.36 / $272.42
| Professional | | $139.55 | $188.36 | $272.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.32 / $2,725.32 / $5,394.42
| Facility | | $2,725.32 | $2,725.32 | $5,394.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.47 / $194.45 / $339.20
| Professional | | $146.47 | $194.45 | $339.20 |