- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.81 / $615.00 / $1,728.00
| Facility | | $201.81 | $615.00 | $1,728.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,696.10 / $11,970.84 / $11,970.84
| Facility | 50 | $11,696.10 | $11,970.84 | $11,970.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $194.00 / $207.38 / $322.91
| Professional | 50 | $194.00 | $207.38 | $322.91 |
- 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
- $241.00 / $847.00 / $1,326.00
| Facility | | $241.00 | $847.00 | $1,326.00 |