- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,819.70 / $2,818.38
| Facility | | $758.58 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $851.14 / $5,128.61
| Professional | | $239.88 | $851.14 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $158.49 / $3,630.78 / $9,549.93
| Professional | 50 | $158.49 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $12,589.25
| Facility | | $8,709.64 | $8,709.64 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Professional | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $3,162.28 / $6,606.93
| Professional | | $245.47 | $3,162.28 | $6,606.93 |
- 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
- $954.99 / $3,548.13 / $11,481.54
| Facility | | $954.99 | $3,548.13 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $3,162.28 / $8,128.31
| Professional | | $245.47 | $3,162.28 | $8,128.31 |