- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,548.13 / $7,585.78
| Facility | | $537.03 | $3,548.13 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $10,715.19
| Facility | 50 | $9,120.11 | $9,120.11 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $2,137.96
| Facility | | $676.08 | $870.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $6,165.95
| Facility | 50 | $5,623.41 | $5,623.41 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,380.38 / $1,380.38
| Professional | | $1,258.93 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $1,096.48
| Professional | | $691.83 | $1,000.00 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |