- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,691.53 / $6,456.54
| Facility | | $741.31 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,548.13 / $6,918.31 / $13,489.63
| Facility | 50 | $3,548.13 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $537.03 / $1,148.15 / $6,760.83
| Professional | 50 | $537.03 | $1,148.15 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $263.03 / $512.86 / $2,454.71
| Professional | 50 | $263.03 | $512.86 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,760.83 / $9,772.37
| Facility | | $3,467.37 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $11,481.54 / $11,481.54
| Facility | | $54.95 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $12,302.69
| Facility | | $4,365.16 | $7,585.78 | $12,302.69 |