- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.38 / $1,247.45 / $17,798.78
| Facility | | $485.38 | $1,247.45 | $17,798.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,654.80 / $1,654.80 / $7,981.92
| Facility | 50 | $1,654.80 | $1,654.80 | $7,981.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.77 / $481.08 / $485.39
| Professional | | $420.77 | $481.08 | $485.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.08 / $632.98 / $825.16
| Professional | | $448.08 | $632.98 | $825.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,044.08 / $12,044.08 / $12,044.08
| Facility | 50 | $12,044.08 | $12,044.08 | $12,044.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.31 / $549.37 / $1,428.50
| Professional | | $399.31 | $549.37 | $1,428.50 |