- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,456.54 / $10,964.78
| Facility | | $1,698.24 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $6,918.31 / $9,772.37
| Facility | 50 | $3,715.35 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $107.15 / $234.42 / $5,754.40
| Professional | 50 | $107.15 | $234.42 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $16,595.87
| Facility | | $6,760.83 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |