- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $8,511.38
| Facility | | $602.56 | $741.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $1,230.27
| Professional | | $575.44 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Professional | 50 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $1,698.24
| Professional | | $1,148.15 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $2,570.40
| Professional | 50 | $1,698.24 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,230.27 / $1,995.26
| Professional | | $562.34 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,023.29 / $1,778.28
| Facility | | $602.56 | $1,023.29 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,318.26 / $7,244.36
| Professional | | $645.65 | $1,318.26 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,311.31 / $5,128.61
| Facility | | $2,570.40 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $1,621.81
| Professional | | $645.65 | $1,096.48 | $1,621.81 |