- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.02 / $2,812.00 / $3,706.14
| Facility | | $1,248.02 | $2,812.00 | $3,706.14 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $821.11 / $2,064.83 / $2,064.83
| Facility | 50 | $821.11 | $2,064.83 | $2,064.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.52 / $301.57 / $354.83
| Professional | | $242.52 | $301.57 | $354.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.47 / $312.32 / $617.99
| Professional | | $265.47 | $312.32 | $617.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.24 / $433.46 / $619.79
| Professional | | $204.24 | $433.46 | $619.79 |
- 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
- $274.64 / $378.32 / $531.21
| Professional | | $274.64 | $378.32 | $531.21 |