- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.30 / $1,251.00 / $2,080.00
| Facility | | $215.30 | $1,251.00 | $2,080.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,047.39 / $1,047.39 / $1,047.39
| Facility | 50 | $1,047.39 | $1,047.39 | $1,047.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.33 / $215.30 / $215.30
| Professional | | $129.33 | $215.30 | $215.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.08 / $1,484.28 / $1,996.84
| Facility | | $1,226.08 | $1,484.28 | $1,996.84 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,839.14 / $2,226.42 / $2,995.25
| Facility | 50 | $1,839.14 | $2,226.42 | $2,995.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.52 / $297.00 / $350.46
| Professional | | $209.52 | $297.00 | $350.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.63 / $190.80 / $529.77
| Professional | | $143.63 | $190.80 | $529.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $1,825.00 / $3,673.36
| Facility | | $625.00 | $1,825.00 | $3,673.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.96 / $147.38 / $228.16
| Professional | | $113.96 | $147.38 | $228.16 |