- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.14 / $47.63 / $12,265.92
| Facility | | $39.14 | $47.63 | $12,265.92 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.99 / $929.30 / $5,483.62
| Facility | 50 | $0.99 | $929.30 | $5,483.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,745.00 / $2,745.00 / $5,698.36
| Professional | 50 | $2,745.00 | $2,745.00 | $5,698.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.45 / $1,470.45 / $1,470.45
| Facility | | $1,470.45 | $1,470.45 | $1,470.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.79 / $559.59 / $970.22
| Professional | | $433.79 | $559.59 | $970.22 |