- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.86 / $3,167.00 / $6,298.62
| Facility | | $2,160.86 | $3,167.00 | $6,298.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,257.40 / $3,201.33 / $3,201.33
| Facility | 50 | $2,257.40 | $3,201.33 | $3,201.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.60 / $864.77 / $1,814.01
| Professional | | $654.60 | $864.77 | $1,814.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $2,263.57 / $15,214.55
| Facility | | $870.00 | $2,263.57 | $15,214.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.64 / $2,274.55 / $6,283.35
| Facility | | $1,173.64 | $2,274.55 | $6,283.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |