- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,128.61 / $16,595.87
| Facility | | $1,122.02 | $5,128.61 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,079.46 / $10,471.29 / $10,471.29
| Facility | 50 | $7,079.46 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,128.61 / $10,471.29
| Facility | | $2,570.40 | $5,128.61 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,754.40 / $10,964.78
| Facility | | $1,230.27 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,122.02 / $3,090.30
| Professional | | $645.65 | $1,122.02 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $9,332.54
| Facility | | $1,584.89 | $4,365.16 | $9,332.54 |