- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,585.78 / $13,489.63
| Facility | | $5,011.87 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $2,754.23 / $3,548.13
| Facility | 50 | $1,258.93 | $2,754.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,000.00 / $19,498.45
| Facility | | $7,585.78 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,318.26 / $6,456.54
| Facility | | $426.58 | $1,318.26 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $1,698.24
| Professional | | $891.25 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,365.16 / $8,128.31
| Facility | | $2,951.21 | $4,365.16 | $8,128.31 |