- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,548.13 / $8,912.51
| Facility | | $602.56 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,023.29 / $5,754.40 / $17,782.79
| Facility | 50 | $1,023.29 | $5,754.40 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,019.95 / $7,244.36
| Facility | | $1,778.28 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $1,513.56
| Professional | | $346.74 | $537.03 | $1,513.56 |
- 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 / $6,165.95
| Facility | | $1,288.25 | $3,548.13 | $6,165.95 |