- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.86 / $1,500.00 / $3,287.52
| Facility | | $550.86 | $1,500.00 | $3,287.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,050.89 / $5,050.89 / $5,050.89
| Facility | 50 | $5,050.89 | $5,050.89 | $5,050.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.02 / $725.35 / $2,052.83
| Professional | | $284.02 | $725.35 | $2,052.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,029.72 / $3,029.72 / $3,635.66
| Facility | | $3,029.72 | $3,029.72 | $3,635.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.75 / $461.39 / $2,031.53
| Professional | | $313.75 | $461.39 | $2,031.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.55 / $614.16 / $2,574.34
| Professional | | $347.55 | $614.16 | $2,574.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,314.00 / $5,652.00
| Facility | | $1,240.00 | $2,314.00 | $5,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.66 / $1,903.68 / $2,916.43
| Professional | | $1,373.66 | $1,903.68 | $2,916.43 |