- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $8,511.38
| Facility | | $426.58 | $524.81 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $891.25
| Professional | | $416.87 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | 50 | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,258.93
| Professional | | $831.76 | $1,023.29 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $1,862.09
| Professional | 50 | $1,230.27 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $912.01 / $1,479.11
| Professional | | $416.87 | $912.01 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,288.25
| Facility | | $426.58 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $891.25 / $5,623.41
| Professional | | $467.74 | $891.25 | $5,623.41 |
- 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
- $467.74 / $794.33 / $1,122.02
| Professional | | $467.74 | $794.33 | $1,122.02 |