- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,463.36 / $10,506.16
| Facility | | $4,277.00 | $5,463.36 | $10,506.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.52 / $2,421.65 / $7,943.37
| Facility | 50 | $0.52 | $2,421.65 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.23 / $737.19 / $2,385.01
| Professional | | $494.23 | $737.19 | $2,385.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.05 / $1,335.50 / $15,526.62
| Facility | | $607.05 | $1,335.50 | $15,526.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.62 / $1,534.02 / $4,487.09
| Facility | | $916.62 | $1,534.02 | $4,487.09 |
- 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 |