- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,981.07 / $7,079.46
| Facility | | $389.05 | $3,981.07 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $6,309.57 / $9,772.37
| Facility | 50 | $4,168.69 | $6,309.57 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $1,230.27
| Professional | | $147.91 | $208.93 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $158.49 / $616.60 / $2,818.38
| Professional | 50 | $158.49 | $616.60 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $2,089.30 / $5,370.32
| Professional | | $186.21 | $2,089.30 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $208.93 / $416.87
| Professional | | $158.49 | $208.93 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $323.59 / $371.54
| Professional | | $154.88 | $323.59 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,606.93 / $26,302.68
| Facility | | $1,023.29 | $6,606.93 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $407.38
| Professional | | $138.04 | $208.93 | $407.38 |