- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,570.40 / $8,912.51
| Facility | | $263.03 | $2,570.40 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $776.25 / $4,265.80 / $12,589.25
| Facility | 50 | $776.25 | $4,265.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $426.58 / $977.24
| Professional | 50 | $147.91 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $13,803.84
| Facility | | $2,398.83 | $7,244.36 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $165.96 / $363.08 / $707.95
| Professional | 50 | $165.96 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $630.96 / $2,089.30
| Facility | | $34.67 | $630.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,174.90 / $3,630.78
| Facility | | $269.15 | $1,174.90 | $3,630.78 |