- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.25 / $3,382.00 / $7,467.00
| Facility | | $946.25 | $3,382.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $657.00 / $1,892.50 / $5,677.50
| Facility | 50 | $657.00 | $1,892.50 | $5,677.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $233.45 / $2,745.00 / $2,745.00
| Professional | 50 | $233.45 | $2,745.00 | $2,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,515.38 / $4,140.09
| Facility | | $672.35 | $2,515.38 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,568.94 / $2,568.94 / $2,568.94
| Facility | | $2,568.94 | $2,568.94 | $2,568.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.28 / $550.82 / $3,787.00
| Facility | | $384.28 | $550.82 | $3,787.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,592.11 / $1,592.11 / $1,592.11
| Facility | 50 | $1,592.11 | $1,592.11 | $1,592.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |