- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.78 / $781.00 / $2,250.00
| Facility | | $635.78 | $781.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,385.20 / $3,385.20 / $9,687.60
| Facility | 50 | $3,385.20 | $3,385.20 | $9,687.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.95 / $700.34 / $897.81
| Professional | | $563.95 | $700.34 | $897.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.62 / $323.62 / $323.62
| Professional | | $323.62 | $323.62 | $323.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,311.29 / $5,231.95 / $7,038.65
| Facility | | $4,311.29 | $5,231.95 | $7,038.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.70 / $1,207.80 / $1,406.30
| Professional | | $854.70 | $1,207.80 | $1,406.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.69 / $924.20 / $2,829.31
| Professional | | $687.69 | $924.20 | $2,829.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $2,891.00 / $4,402.00
| Facility | | $834.00 | $2,891.00 | $4,402.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.74 / $848.41 / $1,375.44
| Professional | | $644.74 | $848.41 | $1,375.44 |