- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $3,567.23 / $3,567.23
| Facility | | $1,400.00 | $3,567.23 | $3,567.23 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,999.58 / $3,999.58 / $3,999.58
| Facility | 50 | $3,999.58 | $3,999.58 | $3,999.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $106.40 / $106.40 / $664.04
| Professional | 50 | $106.40 | $106.40 | $664.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.06 / $461.18 / $502.47
| Facility | | $424.06 | $461.18 | $502.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.75 / $469.75 / $469.75
| Facility | | $469.75 | $469.75 | $469.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,427.08 / $3,427.08 / $3,427.08
| Facility | | $3,427.08 | $3,427.08 | $3,427.08 |