- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.24 / $1,049.56 / $2,191.60
| Facility | | $439.24 | $1,049.56 | $2,191.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.26 / $616.97 / $1,466.49
| Professional | | $405.26 | $616.97 | $1,466.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,144.16 / $1,144.16 / $1,144.16
| Professional | 50 | $1,144.16 | $1,144.16 | $1,144.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.94 / $396.94 / $396.94
| Professional | | $396.94 | $396.94 | $396.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.16 / $355.16 / $355.16
| Facility | | $355.16 | $355.16 | $355.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.50 / $1,086.00 / $1,086.00
| Professional | | $341.50 | $1,086.00 | $1,086.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.27 / $241.27 / $3,776.47
| Facility | | $241.27 | $241.27 | $3,776.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.31 / $785.46 / $1,305.92
| Professional | | $415.31 | $785.46 | $1,305.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,913.00 / $7,175.00
| Facility | | $860.00 | $2,913.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.37 / $849.86 / $1,296.42
| Professional | | $481.37 | $849.86 | $1,296.42 |