- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,513.56 / $2,570.40
| Facility | | $380.19 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,630.78
| Professional | 50 | $3,090.30 | $3,090.30 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $2,454.71
| Facility | | $1,023.29 | $1,023.29 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,621.81 / $4,073.80
| Facility | | $630.96 | $1,621.81 | $4,073.80 |