- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,344.23 / $5,623.41
| Facility | | $234.42 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $724.44
| Professional | | $223.87 | $398.11 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $389.05 / $389.05 / $575.44
| Professional | 50 | $389.05 | $389.05 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,096.48
| Professional | | $489.78 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $389.05 / $1,000.00
| Facility | | $194.98 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $630.96 / $3,801.89
| Professional | | $338.84 | $630.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $912.01
| Professional | | $512.86 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $741.31
| Professional | | $354.81 | $489.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $512.86 / $1,023.29
| Professional | | $263.03 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $851.14
| Professional | | $416.87 | $512.86 | $851.14 |