- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,763.29
| Facility | | $1,000.00 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,745.00 / $2,745.00 / $2,745.00
| Professional | 50 | $2,745.00 | $2,745.00 | $2,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,204.67 / $5,802.00 / $9,302.62
| Facility | | $2,204.67 | $5,802.00 | $9,302.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.11 / $419.01 / $521.41
| Facility | | $278.11 | $419.01 | $521.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,834.00 / $6,599.00 / $7,158.00
| Facility | | $4,834.00 | $6,599.00 | $7,158.00 |