- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $357.97 / $611.87 / $1,099.77
| Professional | | $357.97 | $611.87 | $1,099.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.29 / $1,020.22 / $5,023.00
| Facility | | $520.29 | $1,020.22 | $5,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.72 / $1,210.35 / $1,913.58
| Facility | | $869.72 | $1,210.35 | $1,913.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |