- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.13 / $2,563.00 / $6,066.00
| Facility | | $605.13 | $2,563.00 | $6,066.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $933.45 / $939.52 / $985.92
| Facility | 50 | $933.45 | $939.52 | $985.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.45 / $302.58 / $735.57
| Professional | | $197.45 | $302.58 | $735.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.34 / $478.57 / $1,775.00
| Facility | | $251.34 | $478.57 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.39 / $496.20 / $661.14
| Facility | | $326.39 | $496.20 | $661.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,623.00 / $2,126.00
| Facility | | $1,204.00 | $1,623.00 | $2,126.00 |