- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,801.89 / $13,489.63
| Facility | | $363.08 | $3,801.89 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $7,244.36 / $7,413.10
| Facility | 50 | $3,467.37 | $7,244.36 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $123.03 / $851.14 / $1,584.89
| Professional | 50 | $123.03 | $851.14 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | 50 | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $295.12 / $316.23
| Professional | 50 | $295.12 | $295.12 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |