- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.93 / $5,108.00 / $7,943.37
| Facility | | $1,309.93 | $5,108.00 | $7,943.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,277.58 / $3,277.58 / $7,864.73
| Facility | 50 | $3,277.58 | $3,277.58 | $7,864.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.49 / $695.77 / $2,271.04
| Professional | | $466.49 | $695.77 | $2,271.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.98 / $1,258.64 / $15,526.62
| Facility | | $572.98 | $1,258.64 | $15,526.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.44 / $1,445.37 / $4,487.09
| Facility | | $864.44 | $1,445.37 | $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 |