- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,590.56 / $5,806.00 / $10,651.00
| Facility | | $1,590.56 | $5,806.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,488.82 / $4,092.40 / $12,390.00
| Facility | 50 | $2,488.82 | $4,092.40 | $12,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.00 / $5,126.00 / $9,729.00
| Facility | | $3,434.00 | $5,126.00 | $9,729.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.72 / $729.66 / $994.75
| Facility | | $518.72 | $729.66 | $994.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.93 / $626.07 / $846.77
| Professional | | $472.93 | $626.07 | $846.77 |
- 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 |