- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,344.23 / $8,511.38
| Facility | | $512.86 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,495.41 / $15,488.17 / $15,488.17
| Facility | 50 | $5,495.41 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,786.30 / $6,025.60
| Facility | | $2,454.71 | $4,786.30 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $1,348.96 / $1,949.84
| Professional | | $257.04 | $1,348.96 | $1,949.84 |
- 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 |