- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,951.21 / $6,760.83
| Facility | | $524.81 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $912.01 / $4,168.69 / $6,760.83
| Facility | 50 | $912.01 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | 50 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,011.87 / $8,128.31
| Facility | | $3,162.28 | $5,011.87 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,862.09 / $6,760.83
| Facility | | $446.68 | $1,862.09 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | 50 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |