- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,981.07 / $6,918.31
| Facility | | $2,137.96 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 50 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $1,584.89
| Professional | | $245.47 | $398.11 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $7,244.36
| Facility | | $1,288.25 | $2,344.23 | $7,244.36 |