- 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
- $912.01 / $1,949.84 / $3,311.31
| Facility | 50 | $912.01 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $467.74
| Professional | | $138.04 | $208.93 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.82 / $338.84 / $691.83
| Professional | 50 | $114.82 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $162.18 / $275.42
| Professional | | $123.03 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $251.19 / $331.13
| Professional | | $120.23 | $251.19 | $331.13 |
- 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
- $141.25 / $194.98 / $323.59
| Professional | | $141.25 | $194.98 | $323.59 |