- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,981.07 / $10,715.19
| Facility | | $562.34 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $10,715.19
| Facility | 50 | $1,380.38 | $4,897.79 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $812.83 / $3,630.78
| Professional | 50 | $407.38 | $812.83 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,248.07 / $10,964.78
| Facility | | $1,905.46 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $707.95 / $1,348.96
| Professional | 50 | $501.19 | $707.95 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $4,168.69
| Facility | | $660.69 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |