- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.24 / $2,834.13 / $6,446.00
| Facility | | $1,843.24 | $2,834.13 | $6,446.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,140.63 / $12,140.63 / $12,140.63
| Facility | 50 | $12,140.63 | $12,140.63 | $12,140.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.22 / $910.36 / $1,536.16
| Professional | | $595.22 | $910.36 | $1,536.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.33 / $1,702.63 / $9,834.20
| Facility | | $858.33 | $1,702.63 | $9,834.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.00 / $1,881.77 / $2,865.45
| Facility | | $1,019.00 | $1,881.77 | $2,865.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |