- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,548.13 / $5,128.61
| Facility | | $389.05 | $3,548.13 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,890.45 / $5,248.07 / $5,754.40
| Facility | 50 | $3,890.45 | $5,248.07 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $478.63 / $1,905.46
| Professional | | $134.90 | $478.63 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $1,380.38 / $2,454.71
| Professional | | $181.97 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $489.78 / $1,479.11
| Professional | | $151.36 | $489.78 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $549.54 / $1,348.96
| Professional | | $524.81 | $549.54 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,760.83 / $26,302.68
| Facility | | $1,023.29 | $6,760.83 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $436.52 / $1,288.25
| Professional | | $144.54 | $436.52 | $1,288.25 |