- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.00 / $3,133.00 / $10,651.00
| Facility | | $856.00 | $3,133.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,583.00 / $5,169.57 / $7,861.50
| Facility | 50 | $2,583.00 | $5,169.57 | $7,861.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.00 / $5,126.00 / $9,729.00
| Facility | | $3,434.00 | $5,126.00 | $9,729.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.16 / $456.40 / $635.30
| Facility | | $378.16 | $456.40 | $635.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.50 / $502.04 / $645.48
| Professional | | $407.50 | $502.04 | $645.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,527.00 / $8,586.00 / $15,893.00
| Facility | | $3,527.00 | $8,586.00 | $15,893.00 |