- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.87 / $1,950.59 / $8,500.00
| Facility | | $177.87 | $1,950.59 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,624.51 / $6,624.51 / $7,273.64
| Facility | 50 | $6,624.51 | $6,624.51 | $7,273.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.87 / $1,036.33 / $3,883.96
| Professional | | $177.87 | $1,036.33 | $3,883.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.72 / $460.37 / $4,057.41
| Professional | | $355.72 | $460.37 | $4,057.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $533.58 / $3,043.05 / $5,822.82
| Professional | 50 | $533.58 | $3,043.05 | $5,822.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.14 / $576.65 / $5,128.80
| Professional | | $273.14 | $576.65 | $5,128.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.87 / $1,950.59 / $4,903.22
| Facility | | $177.87 | $1,950.59 | $4,903.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,511.57 / $5,511.57 / $5,511.57
| Facility | 50 | $5,511.57 | $5,511.57 | $5,511.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,508.48 / $4,180.82 / $5,136.71
| Professional | | $2,508.48 | $4,180.82 | $5,136.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.44 / $4,073.85 / $5,136.71
| Professional | | $2,299.44 | $4,073.85 | $5,136.71 |