- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $4,365.16
| Facility | | $676.08 | $676.08 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | 50 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $3,162.28
| Facility | | $851.14 | $1,148.15 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,659.59 / $1,778.28
| Professional | | $1,584.89 | $1,659.59 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,412.54
| Professional | | $912.01 | $1,230.27 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |