- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,168.69 / $9,772.37
| Facility | | $676.08 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | 50 | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,370.32 / $7,585.78
| Facility | | $2,398.83 | $5,370.32 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $616.60 / $2,344.23
| Professional | | $354.81 | $616.60 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,548.13 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |