- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $3,090.30 / $7,943.28
| Facility | | $107.15 | $3,090.30 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.56 / $4,466.84 / $9,120.11
| Facility | 50 | $0.56 | $4,466.84 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $354.81 / $977.24
| Professional | 50 | $147.91 | $354.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $144.54 / $218.78 / $295.12
| Professional | 50 | $144.54 | $218.78 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $204.17 / $776.25
| Facility | | $34.67 | $204.17 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,630.27 / $6,456.54
| Facility | | $1,348.96 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,548.82 / $3,890.45
| Facility | | $269.15 | $1,548.82 | $3,890.45 |