- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,691.53 / $5,888.44
| Facility | | $707.95 | $2,691.53 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $3,715.35
| Facility | 50 | $3,019.95 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $13,182.57 / $17,378.01
| Facility | | $9,332.54 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $5,011.87
| Professional | | $691.83 | $1,023.29 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,786.30 / $19,498.45
| Facility | | $2,951.21 | $4,786.30 | $19,498.45 |