- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,365.16 / $11,481.54
| Facility | | $645.65 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.56 / $4,466.84 / $28,840.32
| Facility | 50 | $0.56 | $4,466.84 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $107.15 / $537.03 / $851.14
| Professional | 50 | $107.15 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $281.84 / $338.84
| Professional | 50 | $251.19 | $281.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,380.38 / $1,862.09
| Facility | | $489.78 | $1,380.38 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,023.29 / $1,122.02
| Facility | | $954.99 | $1,023.29 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,623.41 / $9,772.37
| Facility | | $1,737.80 | $5,623.41 | $9,772.37 |