- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,684.00 / $12,600.00
| Facility | | $1,048.00 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,124.26 / $14,803.42 / $23,300.61
| Facility | 50 | $4,124.26 | $14,803.42 | $23,300.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $603.63 / $603.63 / $603.63
| Professional | 50 | $603.63 | $603.63 | $603.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,681.52 / $4,944.21 / $7,161.81
| Facility | | $3,681.52 | $4,944.21 | $7,161.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.15 / $518.15 / $518.15
| Facility | | $518.15 | $518.15 | $518.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.61 / $2,383.09 / $8,133.20
| Facility | | $457.61 | $2,383.09 | $8,133.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $706.25 / $706.25 / $706.25
| Professional | 50 | $706.25 | $706.25 | $706.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,980.00 / $13,541.98
| Facility | | $1,851.00 | $6,980.00 | $13,541.98 |