- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $467.41 / $1,248.04 / $2,885.47
| Facility | 50 | $467.41 | $1,248.04 | $2,885.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.99 / $355.31 / $481.07
| Professional | | $202.99 | $355.31 | $481.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.69 / $300.60 / $660.83
| Professional | | $211.69 | $300.60 | $660.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $386.25 / $709.96
| Professional | | $150.00 | $386.25 | $709.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.60 / $404.77 / $688.93
| Professional | | $270.60 | $404.77 | $688.93 |