- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $2,570.40
| Facility | | $630.96 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $524.81 / $2,691.53
| Professional | | $154.88 | $524.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Professional | 50 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $954.99 / $1,122.02 / $4,897.79
| Professional | 50 | $954.99 | $1,122.02 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $5,370.32
| Facility | | $3,162.28 | $3,162.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $389.05 / $3,235.94
| Professional | | $154.88 | $389.05 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,548.13 / $11,481.54
| Facility | | $954.99 | $3,548.13 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $1,659.59 / $4,365.16
| Professional | | $151.36 | $1,659.59 | $4,365.16 |