- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.84 / $498.84 / $8,500.00
| Facility | | $498.84 | $498.84 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,809.48 / $5,809.48 / $5,809.48
| Facility | 50 | $5,809.48 | $5,809.48 | $5,809.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.88 / $498.84 / $889.47
| Professional | | $447.88 | $498.84 | $889.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.29 / $1,177.38 / $1,411.42
| Professional | | $1,087.29 | $1,177.38 | $1,411.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.84 / $1,315.99 / $1,699.40
| Professional | | $677.84 | $1,315.99 | $1,699.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.84 / $605.52 / $1,496.52
| Facility | | $498.84 | $605.52 | $1,496.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.77 / $923.48 / $1,293.76
| Professional | | $520.77 | $923.48 | $1,293.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,429.33 / $7,429.33 / $7,429.33
| Facility | | $7,429.33 | $7,429.33 | $7,429.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.77 / $983.60 / $1,293.76
| Professional | | $520.77 | $983.60 | $1,293.76 |