- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.68 / $1,064.00 / $2,812.00
| Facility | | $145.68 | $1,064.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,502.80 / $2,502.80 / $2,502.80
| Facility | 50 | $2,502.80 | $2,502.80 | $2,502.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.51 / $176.86 / $292.25
| Professional | | $74.51 | $176.86 | $292.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.38 / $114.38 / $114.38
| Professional | 50 | $114.38 | $114.38 | $114.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.30 / $655.30 / $786.37
| Facility | | $655.30 | $655.30 | $786.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.87 / $136.57 / $334.81
| Professional | | $92.87 | $136.57 | $334.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.03 / $184.55 / $432.55
| Professional | | $110.03 | $184.55 | $432.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $811.00 / $1,574.00
| Facility | | $330.00 | $811.00 | $1,574.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.75 / $267.45 / $411.66
| Professional | | $183.75 | $267.45 | $411.66 |