- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.23 / $645.27 / $6,907.00
| Facility | | $393.23 | $645.27 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,163.57 / $6,163.57 / $10,303.79
| Facility | 50 | $6,163.57 | $6,163.57 | $10,303.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.01 / $248.84 / $320.85
| Professional | | $153.01 | $248.84 | $320.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $878.00 / $878.00 / $878.00
| Professional | 50 | $878.00 | $878.00 | $878.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.17 / $276.72 / $391.21
| Professional | | $177.17 | $276.72 | $391.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.08 / $365.89 / $571.66
| Professional | | $251.08 | $365.89 | $571.66 |