- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.25 / $1,100.00 / $5,543.69
| Facility | | $259.25 | $1,100.00 | $5,543.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.15 / $259.25 / $411.55
| Professional | | $154.15 | $259.25 | $411.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.69 / $3,144.71 / $4,230.64
| Facility | | $2,597.69 | $3,144.71 | $4,230.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,896.53 / $4,717.06 / $6,345.96
| Facility | 50 | $3,896.53 | $4,717.06 | $6,345.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $265.50 / $366.24
| Professional | | $177.47 | $265.50 | $366.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.03 / $253.69 / $604.28
| Professional | | $157.03 | $253.69 | $604.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $1,768.00 / $3,360.00
| Facility | | $625.00 | $1,768.00 | $3,360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.36 / $273.22 / $416.34
| Professional | | $200.36 | $273.22 | $416.34 |