- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.86 / $2,747.00 / $7,205.00
| Facility | | $554.86 | $2,747.00 | $7,205.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,436.50 / $3,436.50 / $3,436.50
| Facility | 50 | $3,436.50 | $3,436.50 | $3,436.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.18 / $564.91 / $916.78
| Professional | | $263.18 | $564.91 | $916.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,283.00 / $5,125.66 / $10,277.00
| Facility | | $3,283.00 | $5,125.66 | $10,277.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.80 / $558.62 / $1,161.14
| Professional | | $314.80 | $558.62 | $1,161.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,741.63 / $2,140.42 / $3,043.71
| Facility | | $1,741.63 | $2,140.42 | $3,043.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.14 / $593.21 / $1,377.51
| Professional | | $302.14 | $593.21 | $1,377.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,857.50 / $7,911.50
| Facility | | $1,981.00 | $3,857.50 | $7,911.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.45 / $869.27 / $1,673.32
| Professional | | $568.45 | $869.27 | $1,673.32 |