- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $4,365.16
| Facility | | $389.05 | $457.09 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Professional | 50 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,148.15
| Facility | | $426.58 | $660.69 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $891.25 / $1,023.29
| Professional | | $870.96 | $891.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $891.25
| Professional | | $537.03 | $758.58 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |