- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.54 / $1,852.32 / $4,283.52
| Facility | | $100.54 | $1,852.32 | $4,283.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,296.56 / $8,296.56 / $8,296.56
| Facility | 50 | $8,296.56 | $8,296.56 | $8,296.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.55 / $258.41 / $659.36
| Professional | | $97.55 | $258.41 | $659.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.84 / $186.56 / $836.43
| Professional | | $114.84 | $186.56 | $836.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.05 / $768.05 / $3,335.10
| Facility | | $768.05 | $768.05 | $3,335.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,566.31 / $1,566.31 / $5,003.09
| Facility | 50 | $1,566.31 | $1,566.31 | $5,003.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.51 / $648.66 / $1,275.50
| Professional | | $515.51 | $648.66 | $1,275.50 |