- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,862.09 / $4,265.80
| Facility | | $100.00 | $1,862.09 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | 50 | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $257.04 / $1,445.44
| Professional | | $104.71 | $257.04 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.04 / $316.23 / $707.95
| Professional | 50 | $138.04 | $316.23 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $851.14
| Professional | | $114.82 | $186.21 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $3,311.31
| Facility | | $812.83 | $812.83 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $5,011.87
| Facility | 50 | $1,659.59 | $1,659.59 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $363.08 / $794.33
| Professional | | $100.00 | $363.08 | $794.33 |