- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.09 / $2,678.00 / $6,681.00
| Facility | | $381.09 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,821.21 / $1,821.21 / $2,313.00
| Facility | 50 | $1,821.21 | $1,821.21 | $2,313.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $233.45 / $890.37 / $2,745.00
| Professional | 50 | $233.45 | $890.37 | $2,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,959.00
| Facility | | $2,132.00 | $3,728.00 | $5,959.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.10 / $7,909.30 / $26,542.00
| Facility | | $2,291.10 | $7,909.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.00 / $3,616.00 / $6,285.00
| Facility | | $1,695.00 | $3,616.00 | $6,285.00 |