- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $7,244.36 / $13,489.63
| Facility | | $954.99 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $562.34 / $1,202.26 / $3,630.78
| Professional | 50 | $562.34 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $3,019.95
| Facility | | $371.54 | $758.58 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,288.25
| Professional | | $870.96 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $8,128.31
| Facility | | $2,570.40 | $3,162.28 | $8,128.31 |