- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.00 / $2,061.90 / $6,907.00
| Facility | | $152.00 | $2,061.90 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,602.54 / $3,602.54 / $5,294.54
| Facility | 50 | $3,602.54 | $3,602.54 | $5,294.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.00 / $156.69 / $159.62
| Professional | | $152.00 | $156.69 | $159.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.24 / $204.23 / $280.08
| Professional | | $145.24 | $204.23 | $280.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.08 / $2,015.08 / $2,015.08
| Facility | | $2,015.08 | $2,015.08 | $2,015.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.88 / $202.23 / $357.24
| Professional | | $155.88 | $202.23 | $357.24 |