- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,344.23 / $11,220.18
| Facility | | $501.19 | $2,344.23 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $4,786.30 / $5,495.41
| Facility | 50 | $3,090.30 | $4,786.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $213.80 / $741.31 / $1,548.82
| Professional | 50 | $213.80 | $741.31 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | 50 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,317.64 / $10,471.29
| Facility | | $3,715.35 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $436.52 / $537.03 / $831.76
| Professional | 50 | $436.52 | $537.03 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $407.38 / $467.74
| Facility | | $398.11 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |