- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $1,399.00 / $4,137.45
| Facility | | $781.00 | $1,399.00 | $4,137.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.70 / $585.79 / $909.83
| Professional | | $300.70 | $585.79 | $909.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,789.47 / $2,166.30 / $2,914.37
| Facility | | $1,789.47 | $2,166.30 | $2,914.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,684.21 / $3,249.45 / $4,371.55
| Facility | 50 | $2,684.21 | $3,249.45 | $4,371.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.54 / $333.35 / $456.64
| Professional | | $214.54 | $333.35 | $456.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.08 / $391.82 / $1,172.92
| Professional | | $252.08 | $391.82 | $1,172.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $2,891.00 / $4,402.00
| Facility | | $834.00 | $2,891.00 | $4,402.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.54 / $441.41 / $593.94
| Professional | | $352.54 | $441.41 | $593.94 |