- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.89 / $724.89 / $3,073.00
| Facility | | $724.89 | $724.89 | $3,073.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,510.40 / $8,510.40 / $8,967.60
| Facility | 50 | $8,510.40 | $8,510.40 | $8,967.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.51 / $1,069.16 / $2,622.62
| Facility | | $715.51 | $1,069.16 | $2,622.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,086.95 / $1,342.36 / $6,155.86
| Facility | 50 | $1,086.95 | $1,342.36 | $6,155.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.03 / $1,995.23 / $5,638.90
| Facility | | $1,521.03 | $1,995.23 | $5,638.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.78 / $1,419.11 / $1,667.49
| Professional | | $987.78 | $1,419.11 | $1,667.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $4,500.00 / $4,500.00
| Facility | | $4,500.00 | $4,500.00 | $4,500.00 |