- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.63 / $6,479.00 / $11,978.75
| Facility | | $924.63 | $6,479.00 | $11,978.75 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,978.75 / $11,978.75 / $11,978.75
| Facility | 50 | $11,978.75 | $11,978.75 | $11,978.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.00 / $7,478.00 / $13,989.00
| Facility | | $4,427.00 | $7,478.00 | $13,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.66 / $869.86 / $1,305.72
| Facility | | $702.66 | $869.86 | $1,305.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.50 / $907.48 / $1,227.38
| Professional | | $685.50 | $907.48 | $1,227.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,527.00 / $8,586.00 / $15,893.00
| Facility | | $3,527.00 | $8,586.00 | $15,893.00 |