- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,746.37 / $4,746.37 / $4,746.37
| Facility | 50 | $4,746.37 | $4,746.37 | $4,746.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.39 / $697.94 / $1,188.50
| Professional | | $76.39 | $697.94 | $1,188.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.75 / $1,280.97 / $5,244.00
| Facility | | $202.75 | $1,280.97 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.72 / $1,280.97 / $1,813.25
| Facility | | $199.72 | $1,280.97 | $1,813.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,639.63 / $4,663.00 / $7,305.00
| Facility | | $2,639.63 | $4,663.00 | $7,305.00 |