- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.52 / $2,458.60 / $3,204.28
| Facility | 50 | $0.52 | $2,458.60 | $3,204.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.57 / $353.73 / $697.41
| Professional | | $185.57 | $353.73 | $697.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.48 / $647.42 / $14,595.02
| Facility | | $433.48 | $647.42 | $14,595.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.20 / $606.89 / $4,487.09
| Facility | | $417.20 | $606.89 | $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 |