- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.08 / $484.08 / $3,511.00
| Facility | | $484.08 | $484.08 | $3,511.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,597.36 / $5,597.36 / $6,696.86
| Facility | 50 | $5,597.36 | $5,597.36 | $6,696.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.42 / $671.64 / $1,572.95
| Facility | | $397.42 | $671.64 | $1,572.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.52 / $1,134.08 / $1,539.00
| Facility | | $917.52 | $1,134.08 | $1,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.54 / $834.63 / $981.70
| Professional | | $580.54 | $834.63 | $981.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.00 / $2,714.00 / $2,714.00
| Facility | | $2,714.00 | $2,714.00 | $2,714.00 |