- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.57 / $3,908.01 / $13,841.56
| Facility | | $541.57 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $383.23 / $383.23 / $897.15
| Professional | 50 | $383.23 | $383.23 | $897.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,153.73 / $15,116.17 / $28,376.91
| Facility | | $11,153.73 | $15,116.17 | $28,376.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.22 / $365.12 / $550.27
| Facility | | $154.22 | $365.12 | $550.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.73 / $435.96 / $712.08
| Facility | | $262.73 | $435.96 | $712.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |