- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $7,518.12 / $7,518.12
| Facility | | $1,400.00 | $7,518.12 | $7,518.12 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,345.04 / $15,345.04 / $15,345.04
| Facility | 50 | $15,345.04 | $15,345.04 | $15,345.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,234.10 / $1,234.10 / $1,234.10
| Professional | 50 | $1,234.10 | $1,234.10 | $1,234.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.13 / $493.44 / $602.46
| Facility | | $365.13 | $493.44 | $602.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.15 / $626.15 / $626.15
| Facility | | $626.15 | $626.15 | $626.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.16 / $6,032.42 / $16,177.55
| Facility | | $1,294.16 | $6,032.42 | $16,177.55 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,622.32 / $11,977.49 / $13,911.37
| Facility | 50 | $7,622.32 | $11,977.49 | $13,911.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,452.98 / $1,485.20 / $1,485.20
| Professional | 50 | $1,452.98 | $1,485.20 | $1,485.20 |