- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.80 / $779.15 / $8,500.00
| Facility | | $656.80 | $779.15 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.97 / $674.37 / $835.61
| Professional | | $571.97 | $674.37 | $835.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.92 / $1,516.25 / $1,783.83
| Professional | | $1,276.92 | $1,516.25 | $1,783.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,915.38 / $2,253.38 / $2,675.75
| Professional | 50 | $1,915.38 | $2,253.38 | $2,675.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.66 / $1,295.92 / $2,025.11
| Professional | | $598.66 | $1,295.92 | $2,025.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.80 / $932.39 / $1,675.54
| Facility | | $656.80 | $932.39 | $1,675.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.28 / $1,383.26 / $5,606.00
| Professional | | $713.28 | $1,383.26 | $5,606.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.00 / $3,328.00 / $5,025.00
| Facility | | $2,545.00 | $3,328.00 | $5,025.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.53 / $1,212.98 / $1,681.64
| Professional | | $792.53 | $1,212.98 | $1,681.64 |