- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,758.83 / $4,758.83 / $4,758.83
| Facility | 50 | $4,758.83 | $4,758.83 | $4,758.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,745.00 / $2,745.00 / $2,745.00
| Professional | 50 | $2,745.00 | $2,745.00 | $2,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,522.85 / $8,840.12 / $16,595.18
| Facility | | $6,522.85 | $8,840.12 | $16,595.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.53 / $685.18 / $7,772.00
| Facility | | $391.53 | $685.18 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,487.50 / $2,487.50 / $3,548.00
| Facility | 50 | $2,487.50 | $2,487.50 | $3,548.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.54 / $1,030.14 / $2,571.84
| Facility | | $778.54 | $1,030.14 | $2,571.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |