- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.79 / $590.79 / $4,338.00
| Facility | | $590.79 | $590.79 | $4,338.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,047.40 / $3,047.40 / $3,047.40
| Facility | 50 | $3,047.40 | $3,047.40 | $3,047.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.37 / $998.45 / $1,677.73
| Facility | | $738.37 | $998.45 | $1,677.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.00 / $1,617.36 / $6,155.66
| Facility | | $1,062.00 | $1,617.36 | $6,155.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.58 / $1,063.88 / $1,212.94
| Professional | | $794.58 | $1,063.88 | $1,212.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,357.00 / $5,357.00 / $5,357.00
| Facility | | $5,357.00 | $5,357.00 | $5,357.00 |