- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,256.22 / $3,955.04
| Facility | | $2,424.15 | $3,256.22 | $3,955.04 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $914.09 / $1,950.79 / $3,293.98
| Facility | 50 | $914.09 | $1,950.79 | $3,293.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.18 / $141.54 / $197.91
| Professional | | $139.18 | $141.54 | $197.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.51 / $192.37 / $309.56
| Professional | | $163.51 | $192.37 | $309.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.09 / $250.51 / $340.00
| Professional | | $123.09 | $250.51 | $340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.47 / $198.66 / $325.83
| Professional | | $152.47 | $198.66 | $325.83 |