- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,090.30 / $6,456.54
| Facility | | $1,071.52 | $3,090.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,000.00 / $3,981.07 / $7,079.46
| Facility | 50 | $1,000.00 | $3,981.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $213.80 / $741.31 / $1,548.82
| Professional | 50 | $213.80 | $741.31 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $446.68 / $977.24
| Professional | | $426.58 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,803.84 / $26,302.68
| Facility | | $2,344.23 | $13,803.84 | $26,302.68 |