- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.04 / $3,004.00 / $7,602.00
| Facility | | $452.04 | $3,004.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,651.09 / $4,475.85 / $6,120.45
| Facility | 50 | $2,651.09 | $4,475.85 | $6,120.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,722.50 / $2,722.50 / $2,722.50
| Professional | 50 | $2,722.50 | $2,722.50 | $2,722.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $3,931.00 / $8,517.00
| Facility | | $2,393.00 | $3,931.00 | $8,517.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $538.34 / $654.13 / $1,052.86
| Professional | 50 | $538.34 | $654.13 | $1,052.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.98 / $1,023.60 / $1,459.47
| Facility | | $861.98 | $1,023.60 | $1,459.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.00 / $2,898.50 / $5,558.00
| Facility | | $1,552.00 | $2,898.50 | $5,558.00 |