- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $457.09 / $6,456.54
| Professional | | $229.09 | $457.09 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Professional | 50 | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,760.83 / $16,218.10
| Facility | | $2,290.87 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $16,982.44 / $16,982.44
| Professional | | $3,090.30 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,570.40 / $5,623.41
| Professional | | $512.86 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,606.93 / $15,488.17
| Facility | | $3,801.89 | $6,606.93 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $3,630.78 / $8,317.64
| Professional | | $562.34 | $3,630.78 | $8,317.64 |