- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.86 / $3,696.00 / $9,863.00
| Facility | | $393.86 | $3,696.00 | $9,863.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,651.09 / $4,777.38 / $5,912.74
| Facility | 50 | $2,651.09 | $4,777.38 | $5,912.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $551.17 / $551.17 / $956.07
| Professional | 50 | $551.17 | $551.17 | $956.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,792.00 / $8,800.00
| Facility | | $1,145.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $442.60 / $592.09 / $1,047.64
| Professional | 50 | $442.60 | $592.09 | $1,047.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.80 / $585.63 / $688.97
| Facility | | $374.80 | $585.63 | $688.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,551.00 / $5,235.00
| Facility | | $1,689.00 | $2,551.00 | $5,235.00 |