- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.56 / $5,063.00 / $7,313.35
| Facility | | $1,015.56 | $5,063.00 | $7,313.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,353.00 / $4,353.00 / $4,353.00
| Facility | 50 | $4,353.00 | $4,353.00 | $4,353.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.14 / $2,986.70 / $6,271.28
| Facility | | $1,039.14 | $2,986.70 | $6,271.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.46 / $1,348.74 / $74,999.25
| Facility | | $1,115.46 | $1,348.74 | $74,999.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.00 / $1,732.09 / $2,181.15
| Facility | | $778.00 | $1,732.09 | $2,181.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.33 / $1,024.48 / $5,626.08
| Professional | | $704.33 | $1,024.48 | $5,626.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.00 / $6,000.00 / $8,554.00
| Facility | | $990.00 | $6,000.00 | $8,554.00 |