- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $6,606.93 / $12,022.64
| Facility | | $512.86 | $6,606.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,513.56
| Professional | | $478.63 | $776.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,148.15 / $1,380.38
| Professional | | $977.24 | $1,148.15 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $954.99 / $1,479.11
| Professional | | $549.54 | $954.99 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $4,897.79
| Facility | | $467.74 | $794.33 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Facility | 50 | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $831.76 / $4,073.80
| Professional | | $467.74 | $831.76 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,370.32 / $6,918.31
| Facility | | $1,995.26 | $5,370.32 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $707.95 / $1,148.15
| Professional | | $467.74 | $707.95 | $1,148.15 |