- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.26 / $3,429.41 / $3,429.41
| Facility | | $226.26 | $3,429.41 | $3,429.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,111.33 / $3,111.33 / $3,111.33
| Facility | 50 | $3,111.33 | $3,111.33 | $3,111.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.72 / $410.04 / $622.72
| Professional | | $207.72 | $410.04 | $622.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.39 / $708.53 / $1,090.05
| Professional | | $379.39 | $708.53 | $1,090.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $569.09 / $807.45 / $1,628.10
| Professional | 50 | $569.09 | $807.45 | $1,628.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.75 / $630.61 / $1,154.08
| Professional | | $317.75 | $630.61 | $1,154.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.26 / $424.03 / $933.62
| Facility | | $226.26 | $424.03 | $933.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,192.72 / $4,192.72 / $4,192.72
| Facility | 50 | $4,192.72 | $4,192.72 | $4,192.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.06 / $790.46 / $1,646.13
| Professional | | $463.06 | $790.46 | $1,646.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.91 / $762.71 / $948.00
| Professional | | $430.91 | $762.71 | $948.00 |