- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.52 / $993.00 / $2,010.00
| Facility | | $365.52 | $993.00 | $2,010.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,821.21 / $2,313.00 / $6,733.70
| Facility | 50 | $1,821.21 | $2,313.00 | $6,733.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $617.32 / $940.50 / $940.50
| Professional | 50 | $617.32 | $940.50 | $940.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.58 / $1,371.58 / $1,371.58
| Facility | | $1,371.58 | $1,371.58 | $1,371.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.59 / $1,442.59 / $3,384.29
| Facility | | $1,442.59 | $1,442.59 | $3,384.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |