- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.57 / $4,553.99 / $7,277.48
| Facility | | $721.57 | $4,553.99 | $7,277.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.24 / $634.00 / $1,125.65
| Professional | | $303.24 | $634.00 | $1,125.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,322.69 / $2,322.69 / $2,322.69
| Professional | 50 | $2,322.69 | $2,322.69 | $2,322.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.70 / $389.76 / $536.60
| Facility | | $321.70 | $389.76 | $536.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.45 / $346.45 / $389.33
| Professional | | $346.45 | $346.45 | $389.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.84 / $515.84 / $515.84
| Facility | | $515.84 | $515.84 | $515.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.24 / $758.66 / $2,125.35
| Professional | | $334.24 | $758.66 | $2,125.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,716.55 / $14,346.58 / $30,852.76
| Facility | | $11,716.55 | $14,346.58 | $30,852.76 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $18,533.43 / $18,533.43 / $28,693.88
| Facility | 50 | $18,533.43 | $18,533.43 | $28,693.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.40 / $1,003.33 / $2,055.58
| Professional | | $558.40 | $1,003.33 | $2,055.58 |