- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.42 / $520.01 / $8,500.00
| Facility | | $429.42 | $520.01 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.25 / $460.66 / $695.65
| Professional | | $381.25 | $460.66 | $695.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.58 / $1,055.33 / $1,241.56
| Professional | | $845.58 | $1,055.33 | $1,241.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,253.46 / $1,548.90 / $1,862.34
| Professional | 50 | $1,253.46 | $1,548.90 | $1,862.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.14 / $907.37 / $1,417.93
| Professional | | $417.14 | $907.37 | $1,417.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.42 / $730.01 / $1,167.01
| Facility | | $429.42 | $730.01 | $1,167.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.87 / $889.11 / $1,360.62
| Professional | | $474.87 | $889.11 | $1,360.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.00 / $2,545.00 / $2,545.00
| Facility | | $2,545.00 | $2,545.00 | $2,545.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.87 / $800.77 / $1,223.26
| Professional | | $474.87 | $800.77 | $1,223.26 |