- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $5,888.44 / $8,511.38
| Facility | | $446.68 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | 50 | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $562.34 / $562.34 / $3,630.78
| Professional | 50 | $562.34 | $562.34 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,311.31 / $7,244.36
| Facility | | $2,818.38 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,265.80 / $5,011.87 / $10,964.78
| Facility | 50 | $4,265.80 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $588.84 / $812.83
| Professional | | $478.63 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,466.84 / $5,128.61
| Facility | | $1,698.24 | $4,466.84 | $5,128.61 |