- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.00 / $3,606.00 / $10,651.00
| Facility | | $1,937.00 | $3,606.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,468.26 / $7,468.26 / $7,468.26
| Facility | 50 | $7,468.26 | $7,468.26 | $7,468.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,946.00 / $9,472.00 / $17,487.00
| Facility | | $5,946.00 | $9,472.00 | $17,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.63 / $551.98 / $704.41
| Facility | | $418.63 | $551.98 | $704.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.15 / $619.88 / $796.99
| Professional | | $503.15 | $619.88 | $796.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,852.00 / $6,090.00 / $14,057.00
| Facility | | $2,852.00 | $6,090.00 | $14,057.00 |