- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,089.30 / $6,606.93
| Facility | | $794.33 | $2,089.30 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | 50 | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $870.96 / $1,122.02
| Professional | | $141.25 | $870.96 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $3,715.35
| Facility | | $1,479.11 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $933.25 / $1,288.25
| Professional | | $177.83 | $933.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $933.25 / $1,380.38
| Professional | | $165.96 | $933.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $1,096.48 / $4,073.80
| Facility | | $162.18 | $1,096.48 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $6,918.31
| Professional | | $870.96 | $1,230.27 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $3,801.89
| Facility | | $575.44 | $1,995.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $724.44 / $1,412.54
| Professional | | $138.04 | $724.44 | $1,412.54 |