- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,237.81 / $1,237.81 / $1,237.81
| Facility | 50 | $1,237.81 | $1,237.81 | $1,237.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.75 / $134.94 / $183.32
| Professional | | $129.75 | $134.94 | $183.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.96 / $182.30 / $287.02
| Professional | | $154.96 | $182.30 | $287.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.33 / $228.67 / $340.00
| Professional | | $117.33 | $228.67 | $340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $6,188.00
| Facility | | $1,395.00 | $2,384.00 | $6,188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.65 / $170.51 / $252.81
| Professional | | $133.65 | $170.51 | $252.81 |