- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1,698.24 / $4,073.80
| Facility | | $1.00 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $4,570.88
| Facility | 50 | $2,454.71 | $4,466.84 | $4,570.88 |
- 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
- $691.83 / $794.33 / $1,258.93
| Professional | | $691.83 | $794.33 | $1,258.93 |
- 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 |