- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $489.78 / $1,737.80
| Facility | | $199.53 | $489.78 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $12,022.64
| Facility | 50 | $11,748.98 | $11,748.98 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $186.21 / $467.74 / $1,548.82
| Professional | 50 | $186.21 | $467.74 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $134.90 / $194.98 / $234.42
| Professional | 50 | $134.90 | $194.98 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,760.83 / $9,120.11
| Facility | | $5,623.41 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,511.38 / $10,000.00 / $13,803.84
| Facility | 50 | $8,511.38 | $10,000.00 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |