- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,168.69 / $15,135.61
| Facility | | $1,148.15 | $4,168.69 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,332.54 / $33,884.42 / $33,884.42
| Facility | 50 | $9,332.54 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,549.93 / $20,417.38
| Facility | | $5,128.61 | $9,549.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,220.18 / $14,125.38
| Facility | | $5,370.32 | $11,220.18 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,995.26 / $4,897.79
| Professional | | $1,174.90 | $1,995.26 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,495.41 / $12,302.69
| Facility | | $2,089.30 | $5,495.41 | $12,302.69 |