- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.46 / $807.08 / $6,064.03
| Facility | | $57.46 | $807.08 | $6,064.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,979.67 / $5,979.67 / $6,585.46
| Facility | 50 | $5,979.67 | $5,979.67 | $6,585.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.57 / $620.15 / $1,664.62
| Professional | | $405.57 | $620.15 | $1,664.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $720.15 / $720.15 / $720.15
| Professional | 50 | $720.15 | $720.15 | $720.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.31 / $410.42 / $609.64
| Professional | | $341.31 | $410.42 | $609.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.93 / $245.93 / $245.93
| Facility | | $245.93 | $245.93 | $245.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.95 / $645.01 / $1,322.55
| Professional | | $324.95 | $645.01 | $1,322.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.38 / $644.37 / $1,133.47
| Professional | | $507.38 | $644.37 | $1,133.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.46 / $693.77 / $1,159.17
| Professional | | $438.46 | $693.77 | $1,159.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.38 / $507.38 / $714.72
| Professional | | $507.38 | $507.38 | $714.72 |