- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,816.00 / $6,907.00 / $9,606.78
| Facility | | $5,816.00 | $6,907.00 | $9,606.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,606.78 / $9,606.78 / $9,606.78
| Facility | 50 | $9,606.78 | $9,606.78 | $9,606.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.87 / $668.33 / $848.91
| Professional | | $488.87 | $668.33 | $848.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $790.00 / $790.00
| Facility | | $790.00 | $790.00 | $790.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.99 / $624.02 / $1,033.04
| Professional | | $481.99 | $624.02 | $1,033.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.17 / $651.59 / $1,658.11
| Professional | | $576.17 | $651.59 | $1,658.11 |