- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.00 / $1,798.71 / $5,218.14
| Facility | | $396.00 | $1,798.71 | $5,218.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.54 / $1,033.76 / $1,748.92
| Professional | | $84.54 | $1,033.76 | $1,748.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.56 / $258.63 / $1,542.54
| Professional | | $107.56 | $258.63 | $1,542.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $161.34 / $387.94 / $2,313.82
| Professional | 50 | $161.34 | $387.94 | $2,313.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.59 / $650.37 / $2,150.59
| Professional | | $112.59 | $650.37 | $2,150.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.58 / $327.37 / $1,946.09
| Professional | | $107.58 | $327.37 | $1,946.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.00 / $1,884.84 / $5,218.14
| Facility | | $396.00 | $1,884.84 | $5,218.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.10 / $1,012.62 / $1,798.71
| Professional | | $89.10 | $1,012.62 | $1,798.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.94 / $1,834.21 / $2,456.53
| Professional | | $190.94 | $1,834.21 | $2,456.53 |