- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,365.16 / $11,220.18
| Facility | | $602.56 | $4,365.16 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $6,309.57 / $14,454.40
| Facility | 50 | $3,467.37 | $6,309.57 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,862.09
| Professional | | $331.13 | $562.34 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,079.46 / $14,454.40
| Facility | | $2,344.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $512.86 / $977.24
| Professional | | $263.03 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,445.44 / $4,073.80
| Facility | | $501.19 | $1,445.44 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $1,412.54
| Professional | | $389.05 | $630.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,265.80 / $10,000.00
| Facility | | $1,548.82 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $512.86 / $1,000.00
| Professional | | $338.84 | $512.86 | $1,000.00 |