- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $5,370.32
| Facility | | $3,890.45 | $3,890.45 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $7,762.47
| Facility | 50 | $1,778.28 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $2,570.40 / $4,466.84
| Professional | | $154.88 | $2,570.40 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $512.86 / $3,630.78 / $9,332.54
| Professional | 50 | $512.86 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $630.96 / $630.96
| Professional | | $316.23 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $524.81 / $933.25
| Professional | 50 | $263.03 | $524.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $371.54
| Professional | | $208.93 | $275.42 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $5,370.32
| Facility | | $1,258.93 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $316.23 / $562.34
| Professional | | $190.55 | $316.23 | $562.34 |