- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,099.72 / $6,099.72 / $7,250.09
| Facility | | $6,099.72 | $6,099.72 | $7,250.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,008.80 / $2,008.80 / $2,008.80
| Facility | 50 | $2,008.80 | $2,008.80 | $2,008.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.94 / $4,050.00 / $7,023.60
| Professional | | $526.94 | $4,050.00 | $7,023.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.60 / $1,373.60 / $1,373.60
| Facility | | $1,373.60 | $1,373.60 | $1,373.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.00 / $1,201.00 / $1,818.00
| Professional | | $1,001.00 | $1,201.00 | $1,818.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.27 / $1,038.82 / $1,457.63
| Professional | | $693.27 | $1,038.82 | $1,457.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.81 / $1,033.81 / $1,690.01
| Professional | | $719.81 | $1,033.81 | $1,690.01 |