- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $5,248.07
| Facility | | $2,570.40 | $4,365.16 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 50 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $8,709.64
| Professional | | $177.83 | $323.59 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $257.04 / $912.01 / $12,022.64
| Professional | 50 | $257.04 | $912.01 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $794.33
| Professional | | $389.05 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $323.59 / $707.95 / $1,174.90
| Professional | 50 | $323.59 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $524.81 / $1,000.00
| Professional | | $302.00 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,754.23 / $10,471.29
| Facility | | $2,630.27 | $2,754.23 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $1,202.26
| Professional | | $316.23 | $524.81 | $1,202.26 |