- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,090.30 / $8,511.38
| Facility | | $575.44 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $38,904.51
| Facility | 50 | $2,238.72 | $4,265.80 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,623.41 / $8,511.38
| Facility | | $2,290.87 | $5,623.41 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $776.25 / $2,570.40
| Professional | | $446.68 | $776.25 | $2,570.40 |
- 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
- $1,584.89 / $4,365.16 / $9,332.54
| Facility | | $1,584.89 | $4,365.16 | $9,332.54 |