- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.97 / $257.92 / $2,000.00
| Facility | | $131.97 | $257.92 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,111.11 / $3,111.11 / $3,111.11
| Facility | 50 | $3,111.11 | $3,111.11 | $3,111.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.96 / $215.15 / $301.91
| Professional | | $115.96 | $215.15 | $301.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.75 / $509.54 / $661.49
| Professional | | $257.75 | $509.54 | $661.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $386.63 / $548.57 / $992.24
| Professional | 50 | $386.63 | $548.57 | $992.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.80 / $421.53 / $847.76
| Professional | | $215.80 | $421.53 | $847.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.97 / $257.92 / $752.56
| Facility | | $131.97 | $257.92 | $752.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.01 / $470.82 / $1,262.00
| Professional | | $262.01 | $470.82 | $1,262.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.01 / $423.74 / $675.03
| Professional | | $262.01 | $423.74 | $675.03 |