- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.02 / $2,740.89 / $6,367.25
| Facility | | $325.02 | $2,740.89 | $6,367.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.44 / $543.74 / $864.48
| Professional | | $338.44 | $543.74 | $864.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.69 / $832.85 / $1,127.84
| Professional | | $645.69 | $832.85 | $1,127.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $968.54 / $1,249.28 / $1,691.78
| Professional | 50 | $968.54 | $1,249.28 | $1,691.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.86 / $728.65 / $1,164.58
| Professional | | $533.86 | $728.65 | $1,164.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.02 / $552.54 / $2,266.00
| Facility | | $325.02 | $552.54 | $2,266.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.14 / $1,104.23 / $1,527.96
| Professional | | $543.14 | $1,104.23 | $1,527.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.37 / $1,123.34 / $1,527.96
| Professional | | $771.37 | $1,123.34 | $1,527.96 |