- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,570.40 / $5,248.07
| Facility | | $912.01 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 50 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $549.54 / $1,122.02
| Professional | | $316.23 | $549.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $741.31
| Professional | | $371.54 | $501.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $562.34 / $933.25
| Professional | | $151.36 | $562.34 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $8,128.31
| Facility | | $2,570.40 | $4,677.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $933.25
| Professional | | $338.84 | $562.34 | $933.25 |