- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.08 / $6,292.46 / $7,980.72
| Facility | | $272.08 | $6,292.46 | $7,980.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.41 / $721.80 / $1,385.08
| Professional | | $281.41 | $721.80 | $1,385.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.54 / $694.37 / $2,367.09
| Professional | | $536.54 | $694.37 | $2,367.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $804.81 / $1,041.56 / $3,550.64
| Professional | 50 | $804.81 | $1,041.56 | $3,550.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.26 / $780.61 / $3,206.82
| Professional | | $373.26 | $780.61 | $3,206.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.08 / $1,385.08 / $4,227.63
| Facility | | $272.08 | $1,385.08 | $4,227.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.36 / $2,750.71 / $3,634.37
| Professional | | $321.36 | $2,750.71 | $3,634.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,753.00 / $5,753.00 / $5,753.00
| Facility | | $5,753.00 | $5,753.00 | $5,753.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.97 / $2,922.34 / $3,634.37
| Professional | | $1,404.97 | $2,922.34 | $3,634.37 |