- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,079.46 / $18,620.87
| Facility | | $1,318.26 | $7,079.46 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,818.38 / $9,332.54 / $19,054.61
| Facility | 50 | $2,818.38 | $9,332.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $21,379.62
| Facility | | $8,912.51 | $10,715.19 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,715.19 / $17,378.01
| Facility | | $6,760.83 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $8,912.51
| Professional | | $1,023.29 | $1,621.81 | $8,912.51 |
- 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
- $2,570.40 / $6,456.54 / $16,982.44
| Facility | | $2,570.40 | $6,456.54 | $16,982.44 |