- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.41 / $3,530.58 / $6,907.00
| Facility | | $1,376.41 | $3,530.58 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,521.67 / $3,202.26 / $3,530.58
| Facility | 50 | $2,521.67 | $3,202.26 | $3,530.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.93 / $333.54 / $415.50
| Professional | | $249.93 | $333.54 | $415.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.97 / $402.56 / $577.29
| Professional | | $275.97 | $402.56 | $577.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,928.55 / $4,928.55 / $6,687.25
| Facility | | $4,928.55 | $4,928.55 | $6,687.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,420.94 / $3,420.94 / $3,420.94
| Facility | 50 | $3,420.94 | $3,420.94 | $3,420.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.05 / $450.49 / $851.66
| Professional | | $374.05 | $450.49 | $851.66 |