- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,819.70 / $1,995.26
| Facility | | $537.03 | $1,819.70 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $1,258.93
| Professional | | $426.58 | $588.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $588.84 / $588.84 / $3,467.37
| Professional | 50 | $588.84 | $588.84 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,174.90 / $2,691.53
| Facility | | $1,071.52 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $1,023.29
| Professional | | $398.11 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,691.53 / $6,025.60
| Facility | | $812.83 | $2,691.53 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $954.99
| Professional | | $407.38 | $524.81 | $954.99 |