- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,981.07 / $5,011.87
| Facility | | $758.58 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 50 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $389.05 / $1,000.00
| Professional | | $316.23 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $2,398.83 / $6,025.60
| Professional | | $346.74 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $398.11 / $851.14
| Professional | | $309.03 | $398.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $288.40 / $660.69
| Professional | | $275.42 | $288.40 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,454.40 / $26,302.68
| Facility | | $2,344.23 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $741.31
| Professional | | $269.15 | $380.19 | $741.31 |