- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $741.31 / $5,754.40
| Facility | | $1.00 | $741.31 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.98 / $3,548.13 / $4,897.79
| Facility | 50 | $0.98 | $3,548.13 | $4,897.79 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $758.58 / $1,202.26
| Professional | | $660.69 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |