- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $3,981.07
| Facility | | $2,398.83 | $3,235.94 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $3,630.78
| Facility | 50 | $1,230.27 | $1,230.27 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $436.52
| Professional | | $128.82 | $147.91 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $154.88 / $257.04
| Professional | | $117.49 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $229.09 / $309.03
| Professional | | $117.49 | $229.09 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $181.97 / $309.03
| Professional | | $120.23 | $181.97 | $309.03 |