- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $2,884.03
| Professional | | $316.23 | $489.78 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Professional | 50 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $40,738.03 / $57,543.99
| Facility | | $16,982.44 | $40,738.03 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $524.81
| Facility | | $446.68 | $501.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,630.78 / $7,585.78
| Facility | | $524.81 | $3,630.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $15,135.61
| Professional | | $1,737.80 | $2,238.72 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $22,387.21
| Facility | | $10,232.93 | $10,232.93 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $3,090.30 / $7,079.46
| Professional | | $501.19 | $3,090.30 | $7,079.46 |