- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $2,041.74
| Facility | | $691.83 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,318.26
| Professional | | $512.86 | $724.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | 50 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,202.26
| Facility | | $891.25 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $741.31 / $977.24
| Professional | | $645.65 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,202.26
| Professional | | $512.86 | $812.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,288.25 / $2,884.03
| Facility | | $588.84 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $1,174.90
| Professional | | $537.03 | $676.08 | $1,174.90 |