- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.47 / $562.37 / $812.64
| Professional | | $150.47 | $562.37 | $812.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $775.11 / $775.11 / $1,005.30
| Professional | 50 | $775.11 | $775.11 | $1,005.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,686.57 / $3,915.98 / $4,965.47
| Facility | | $3,686.57 | $3,915.98 | $4,965.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.12 / $1,016.09 / $1,473.94
| Professional | | $943.12 | $1,016.09 | $1,473.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.69 / $362.42 / $1,473.94
| Professional | | $163.69 | $362.42 | $1,473.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.02 / $628.92 / $1,473.94
| Professional | | $215.02 | $628.92 | $1,473.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.91 / $651.52 / $1,809.09
| Professional | | $511.91 | $651.52 | $1,809.09 |