- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $2,570.40
| Facility | | $630.96 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $467.74 / $3,388.44
| Professional | | $144.54 | $467.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | 50 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Professional | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $3,467.37
| Facility | | $1,479.11 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $354.81 / $4,265.80
| Professional | | $151.36 | $354.81 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,754.23 / $11,481.54
| Facility | | $812.83 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $1,659.59 / $5,370.32
| Professional | | $138.04 | $1,659.59 | $5,370.32 |