- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $3,795.64 / $6,515.67
| Facility | | $2,234.00 | $3,795.64 | $6,515.67 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,866.90 / $1,866.90 / $1,866.90
| Facility | 50 | $1,866.90 | $1,866.90 | $1,866.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.71 / $759.63 / $1,159.76
| Professional | | $507.71 | $759.63 | $1,159.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.25 / $1,096.17 / $7,155.00
| Facility | | $540.25 | $1,096.17 | $7,155.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.51 / $1,264.97 / $2,256.42
| Facility | | $727.51 | $1,264.97 | $2,256.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |