- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $846.24 / $942.40 / $1,368.18
| Professional | 50 | $846.24 | $942.40 | $1,368.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.46 / $299.35 / $1,033.75
| Professional | | $111.46 | $299.35 | $1,033.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.38 / $435.96 / $726.67
| Facility | | $197.38 | $435.96 | $726.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.73 / $435.96 / $712.08
| Facility | | $262.73 | $435.96 | $712.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,623.00 / $2,126.00
| Facility | | $1,026.00 | $1,623.00 | $2,126.00 |