- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,344.23 / $7,762.47
| Facility | | $588.84 | $2,344.23 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.58 / $3,019.95 / $10,471.29
| Facility | 50 | $0.58 | $3,019.95 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $776.25 / $1,548.82
| Professional | 50 | $234.42 | $776.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $251.19 / $281.84
| Professional | 50 | $251.19 | $251.19 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,786.30 / $8,317.64
| Facility | | $2,089.30 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $645.65 / $1,445.44
| Professional | | $371.54 | $645.65 | $1,445.44 |
- 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 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |