- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,801.89 / $12,882.50
| Facility | | $954.99 | $3,801.89 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $12,022.64
| Facility | 50 | $1,023.29 | $1,023.29 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,128.31 / $15,848.93
| Facility | | $6,165.95 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,318.26 / $8,709.64
| Facility | | $645.65 | $1,318.26 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,995.26
| Professional | | $1,445.44 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,888.44 / $8,912.51
| Facility | | $4,677.35 | $5,888.44 | $8,912.51 |