- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.87 / $1,399.00 / $3,336.07
| Facility | | $613.87 | $1,399.00 | $3,336.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,970.84 / $11,970.84 / $14,275.95
| Facility | 50 | $11,970.84 | $11,970.84 | $14,275.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $592.07 / $632.91 / $2,400.30
| Professional | 50 | $592.07 | $632.91 | $2,400.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,494.54 / $6,651.58 / $8,948.50
| Facility | | $5,494.54 | $6,651.58 | $8,948.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,241.79 / $9,977.36 / $13,422.75
| Facility | 50 | $8,241.79 | $9,977.36 | $13,422.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.00 / $4,997.00 / $9,102.00
| Facility | | $1,404.00 | $4,997.00 | $9,102.00 |