- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.89 / $1,397.00 / $4,478.00
| Facility | | $472.89 | $1,397.00 | $4,478.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $657.75 / $1,821.21 / $3,615.03
| Facility | 50 | $657.75 | $1,821.21 | $3,615.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $336.60 / $336.60 / $1,009.80
| Professional | 50 | $336.60 | $336.60 | $1,009.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,893.49 / $2,893.49 / $3,472.19
| Facility | | $2,893.49 | $2,893.49 | $3,472.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,734.43 / $1,734.43 / $1,734.43
| Facility | | $1,734.43 | $1,734.43 | $1,734.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,233.00
| Facility | | $980.00 | $1,650.00 | $4,233.00 |