- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.20 / $973.07 / $8,179.74
| Facility | | $240.20 | $973.07 | $8,179.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.63 / $425.04 / $973.07
| Professional | | $139.63 | $425.04 | $973.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,014.42 / $2,438.62 / $3,280.73
| Facility | | $2,014.42 | $2,438.62 | $3,280.73 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,021.64 / $3,657.94 / $4,921.10
| Facility | 50 | $3,021.64 | $3,657.94 | $4,921.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.28 / $460.62 / $746.02
| Professional | | $206.28 | $460.62 | $746.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.19 / $453.77 / $969.87
| Professional | | $130.19 | $453.77 | $969.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $1,768.00 / $3,360.00
| Facility | | $625.00 | $1,768.00 | $3,360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.62 / $504.42 / $781.63
| Professional | | $169.62 | $504.42 | $781.63 |