- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.36 / $2,225.11 / $3,034.04
| Facility | | $65.36 | $2,225.11 | $3,034.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,673.62 / $3,984.29 / $5,248.54
| Facility | 50 | $2,673.62 | $3,984.29 | $5,248.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.77 / $1,398.80 / $2,858.54
| Professional | | $313.77 | $1,398.80 | $2,858.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $377.48 / $1,573.53 / $2,360.30
| Professional | 50 | $377.48 | $1,573.53 | $2,360.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.42 / $312.42 / $406.15
| Professional | | $312.42 | $312.42 | $406.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.24 / $1,072.56 / $3,083.60
| Professional | | $338.24 | $1,072.56 | $3,083.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.12 / $2,033.18 / $3,106.81
| Professional | | $541.12 | $2,033.18 | $3,106.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.19 / $1,888.64 / $3,295.74
| Professional | | $1,444.19 | $1,888.64 | $3,295.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.41 / $1,882.57 / $2,436.09
| Professional | | $268.41 | $1,882.57 | $2,436.09 |