- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,003.07 / $2,003.07 / $2,003.07
| Facility | 50 | $2,003.07 | $2,003.07 | $2,003.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.92 / $589.48 / $734.98
| Professional | | $507.92 | $589.48 | $734.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.75 / $771.77 / $995.59
| Professional | | $598.75 | $771.77 | $995.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.51 / $666.06 / $1,318.65
| Professional | | $420.51 | $666.06 | $1,318.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.23 / $660.44 / $1,000.42
| Professional | | $434.23 | $660.44 | $1,000.42 |