- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,548.13 / $7,943.28
| Facility | | $457.09 | $3,548.13 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $239.88 / $1,202.26 / $3,630.78
| Professional | 50 | $239.88 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $707.95 / $1,047.13
| Professional | 50 | $524.81 | $707.95 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $11,748.98
| Facility | | $354.81 | $676.08 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $3,019.95
| Facility | | $1,071.52 | $1,412.54 | $3,019.95 |