- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,754.46 / $9,577.00 / $14,552.94
| Facility | | $1,754.46 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.94 / $616.91 / $2,960.17
| Professional | | $472.94 | $616.91 | $2,960.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $181.94 / $1,281.83 / $2,174.71
| Professional | 50 | $181.94 | $1,281.83 | $2,174.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.51 / $1,055.53 / $1,970.39
| Professional | | $941.51 | $1,055.53 | $1,970.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.79 / $3,712.51 / $4,144.24
| Facility | | $2,651.79 | $3,712.51 | $4,144.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.68 / $1,575.61 / $1,803.96
| Professional | | $1,332.68 | $1,575.61 | $1,803.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.86 / $2,258.10 / $2,605.50
| Professional | | $1,329.86 | $2,258.10 | $2,605.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.79 / $3,712.51 / $4,144.24
| Facility | | $2,651.79 | $3,712.51 | $4,144.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.94 / $1,822.43 / $3,550.89
| Professional | | $909.94 | $1,822.43 | $3,550.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.71 / $1,576.32 / $2,378.04
| Professional | | $662.71 | $1,576.32 | $2,378.04 |