- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,187.76 / $9,549.93
| Facility | | $794.33 | $2,187.76 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $13,489.63
| Facility | 50 | $1,096.48 | $3,981.07 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $15,488.17
| Facility | | $4,466.84 | $11,748.98 | $15,488.17 |
- 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
- $512.86 / $1,202.26 / $5,754.40
| Professional | | $512.86 | $1,202.26 | $5,754.40 |
- 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 |