- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,421.65 / $2,421.65 / $11,797.10
| Facility | 50 | $2,421.65 | $2,421.65 | $11,797.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.97 / $657.74 / $2,239.08
| Professional | | $440.97 | $657.74 | $2,239.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.71 / $1,190.19 / $15,526.62
| Facility | | $540.71 | $1,190.19 | $15,526.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.43 / $1,365.09 / $4,487.09
| Facility | | $817.43 | $1,365.09 | $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 |