- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,290.87 / $4,570.88
| Facility | | $676.08 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,023.29 / $2,691.53 / $2,691.53
| Facility | 50 | $1,023.29 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $331.13 / $933.25
| Professional | | $104.71 | $331.13 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $141.25 / $239.88
| Professional | 50 | $138.04 | $141.25 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $537.03 / $1,258.93
| Professional | | $104.71 | $537.03 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $331.13 / $1,862.09
| Professional | | $100.00 | $331.13 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $1,412.54
| Professional | | $616.60 | $660.69 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,737.80 / $10,471.29
| Facility | | $741.31 | $1,737.80 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $275.42 / $1,202.26
| Professional | | $93.33 | $275.42 | $1,202.26 |