- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.13 / $975.04 / $6,500.00
| Facility | | $241.13 | $975.04 | $6,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,889.82 / $6,889.82 / $6,889.82
| Facility | 50 | $6,889.82 | $6,889.82 | $6,889.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.13 / $276.14 / $509.13
| Professional | | $241.13 | $276.14 | $509.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.68 / $645.48 / $1,083.75
| Professional | | $478.68 | $645.48 | $1,083.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $718.02 / $929.25 / $1,596.89
| Professional | 50 | $718.02 | $929.25 | $1,596.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.54 / $728.92 / $1,360.79
| Professional | | $348.54 | $728.92 | $1,360.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.13 / $421.93 / $723.39
| Facility | | $241.13 | $421.93 | $723.39 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.57 / $0.57 / $4,579.12
| Facility | 50 | $0.57 | $0.57 | $4,579.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.74 / $539.52 / $1,100.94
| Professional | | $296.74 | $539.52 | $1,100.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $774.03 / $1,199.85
| Professional | | $346.11 | $774.03 | $1,199.85 |