- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,818.38 / $5,888.44
| Facility | | $426.58 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | 50 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $512.86 / $602.56 / $776.25
| Professional | 50 | $512.86 | $602.56 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $1,288.25
| Professional | | $363.08 | $537.03 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,995.26 / $6,309.57
| Facility | | $724.44 | $1,995.26 | $6,309.57 |