- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $6,760.83 / $9,332.54
| Facility | | $426.58 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $8,709.64
| Facility | 50 | $4,570.88 | $7,079.46 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $302.00 / $1,023.29
| Professional | | $134.90 | $302.00 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $112.20 / $338.84 / $1,584.89
| Professional | 50 | $112.20 | $338.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $724.44
| Professional | | $154.88 | $281.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,888.44 / $15,848.93
| Facility | | $2,754.23 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,244.36 / $17,782.79 / $17,782.79
| Facility | 50 | $7,244.36 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $354.81 / $724.44
| Professional | | $154.88 | $354.81 | $724.44 |