- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,365.16 / $5,495.41
| Facility | | $457.09 | $4,365.16 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 50 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Professional | 50 | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $1,047.13
| Facility | | $446.68 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $870.96 / $891.25
| Professional | | $794.33 | $870.96 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $812.83
| Professional | | $426.58 | $676.08 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |