- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,677.35 / $10,471.29
| Facility | | $1,023.29 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $4,466.84
| Facility | 50 | $2,344.23 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $1,584.89
| Professional | | $416.87 | $537.03 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $724.44 / $1,862.09
| Professional | | $371.54 | $724.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $977.24
| Professional | | $549.54 | $741.31 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,882.50 / $19,498.45
| Facility | | $7,943.28 | $12,882.50 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,288.25
| Professional | | $416.87 | $588.84 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,585.78 / $15,135.61
| Facility | | $3,630.78 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $1,000.00
| Professional | | $288.40 | $467.74 | $1,000.00 |