- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,897.79 / $12,882.50
| Facility | | $851.14 | $4,897.79 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,548.13 / $8,511.38 / $21,877.62
| Facility | 50 | $3,548.13 | $8,511.38 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $1,230.27 / $7,585.78
| Professional | 50 | $501.19 | $1,230.27 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,943.28 / $16,982.44
| Facility | | $3,235.94 | $7,943.28 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $2,290.87 / $5,248.07
| Professional | 50 | $524.81 | $2,290.87 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $5,495.41 / $15,488.17
| Facility | | $34.67 | $5,495.41 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,511.38 / $18,197.01
| Facility | | $2,818.38 | $8,511.38 | $18,197.01 |