- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.80 / $1,958.00 / $3,884.00
| Facility | | $550.80 | $1,958.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,269.75 / $26,035.51 / $28,974.02
| Facility | 50 | $1,269.75 | $26,035.51 | $28,974.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $311.22 / $595.37 / $622.42
| Professional | 50 | $311.22 | $595.37 | $622.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,101.56 / $9,866.64 / $16,898.15
| Facility | | $5,101.56 | $9,866.64 | $16,898.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.04 / $4,688.89 / $4,688.89
| Facility | | $324.04 | $4,688.89 | $4,688.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $7,100.00 / $13,506.00
| Facility | | $1,284.00 | $7,100.00 | $13,506.00 |