- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,513.56 / $2,570.40
| Facility | | $707.95 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $1,122.02 / $2,089.30
| Professional | | $281.84 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | 50 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $977.24 / $1,288.25
| Professional | | $323.59 | $977.24 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $3,801.89
| Facility | | $1,659.59 | $1,659.59 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,288.25 / $2,951.21
| Professional | | $309.03 | $1,288.25 | $2,951.21 |
- 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
- $851.14 / $3,235.94 / $7,244.36
| Facility | | $851.14 | $3,235.94 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,230.27 / $3,388.44
| Professional | | $295.12 | $1,230.27 | $3,388.44 |