- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.98 / $1,622.16 / $20,203.13
| Facility | | $417.98 | $1,622.16 | $20,203.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.22 / $513.11 / $1,622.16
| Professional | | $318.22 | $513.11 | $1,622.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.08 / $597.84 / $1,457.38
| Professional | | $292.08 | $597.84 | $1,457.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $438.13 / $896.76 / $2,186.07
| Professional | 50 | $438.13 | $896.76 | $2,186.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.90 / $1,307.05 / $2,436.42
| Professional | | $392.90 | $1,307.05 | $2,436.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.91 / $598.46 / $1,534.92
| Professional | | $302.91 | $598.46 | $1,534.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,452.38 / $6,452.38 / $20,203.13
| Facility | | $6,452.38 | $6,452.38 | $20,203.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.22 / $494.11 / $1,622.16
| Professional | | $318.22 | $494.11 | $1,622.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.61 / $1,646.52 / $1,987.18
| Professional | | $1,362.61 | $1,646.52 | $1,987.18 |