- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,819.00 / $7,467.00
| Facility | | $1,965.00 | $3,819.00 | $7,467.00 |
- 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
- $672.35 / $2,613.46 / $4,140.09
| Facility | | $672.35 | $2,613.46 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.27 / $454.34 / $2,819.10
| Facility | | $372.27 | $454.34 | $2,819.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.00 / $2,567.00 / $5,105.00
| Facility | | $1,584.00 | $2,567.00 | $5,105.00 |