- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $9,185.68
| Facility | | $4,146.00 | $5,091.00 | $9,185.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,054.31 / $6,054.31 / $10,506.50
| Facility | 50 | $6,054.31 | $6,054.31 | $10,506.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.20 / $1,134.04 / $1,939.55
| Professional | | $657.20 | $1,134.04 | $1,939.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.72 / $2,017.38 / $9,834.20
| Facility | | $1,324.72 | $2,017.38 | $9,834.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,983.77 / $2,865.45
| Facility | | $1,287.00 | $1,983.77 | $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 |