- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $4,014.00 / $7,119.04
| Facility | | $934.00 | $4,014.00 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,622.85 / $2,622.85 / $4,758.83
| Facility | 50 | $2,622.85 | $2,622.85 | $4,758.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.55 / $665.05 / $1,906.17
| Professional | | $348.55 | $665.05 | $1,906.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.39 / $1,406.69 / $14,595.02
| Facility | | $862.39 | $1,406.69 | $14,595.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.86 / $1,142.33 / $4,487.09
| Facility | | $783.86 | $1,142.33 | $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 |