- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,258.93 / $2,238.72
| Facility | | $676.08 | $1,258.93 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $616.60 / $2,570.40 / $6,309.57
| Facility | 50 | $616.60 | $2,570.40 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | 50 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Professional | 50 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,786.30 / $6,456.54
| Facility | | $3,981.07 | $4,786.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,025.60 / $7,079.46 / $9,549.93
| Facility | 50 | $6,025.60 | $7,079.46 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,951.21 / $4,365.16
| Facility | | $831.76 | $2,951.21 | $4,365.16 |