- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $8,511.38
| Facility | | $457.09 | $645.65 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $977.24
| Professional | | $398.11 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,148.15 / $1,479.11
| Professional | | $870.96 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $2,238.72
| Professional | 50 | $1,318.26 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,023.29 / $1,621.81
| Professional | | $489.78 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $1,412.54
| Facility | | $457.09 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,148.15 / $4,168.69
| Professional | | $588.84 | $1,148.15 | $4,168.69 |
- 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
- $537.03 / $831.76 / $1,318.26
| Professional | | $537.03 | $831.76 | $1,318.26 |