- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.50 / $3,955.04 / $11,584.36
| Facility | | $1,537.50 | $3,955.04 | $11,584.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,302.02 / $6,277.38 / $9,564.37
| Facility | 50 | $4,302.02 | $6,277.38 | $9,564.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.50 / $425.64 / $556.37
| Professional | | $415.50 | $425.64 | $556.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.75 / $505.59 / $739.84
| Professional | | $429.75 | $505.59 | $739.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $620.04 / $860.64
| Professional | | $250.00 | $620.04 | $860.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,599.00 / $7,228.00 / $12,680.00
| Facility | | $3,599.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.77 / $592.66 / $911.35
| Professional | | $395.77 | $592.66 | $911.35 |