- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.06 / $511.06 / $4,338.00
| Facility | | $511.06 | $511.06 | $4,338.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,421.65 / $2,421.65 / $2,421.65
| Facility | 50 | $2,421.65 | $2,421.65 | $2,421.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.54 / $704.48 / $1,235.53
| Facility | | $487.54 | $704.48 | $1,235.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.49 / $1,302.33 / $5,700.72
| Facility | | $913.49 | $1,302.33 | $5,700.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.48 / $846.56 / $965.17
| Professional | | $624.48 | $846.56 | $965.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,143.00 / $3,143.00 / $3,143.00
| Facility | | $3,143.00 | $3,143.00 | $3,143.00 |