- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,691.53 / $14,454.40
| Facility | | $371.54 | $2,691.53 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1.00 / $4,570.88 / $6,309.57
| Facility | 50 | $1.00 | $4,570.88 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $371.54 / $575.44
| Professional | | $323.59 | $371.54 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |