- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $7,762.47
| Facility | | $1,288.25 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $2,884.03 / $4,265.80
| Professional | | $234.42 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $181.97 / $181.97 / $3,715.35
| Professional | 50 | $181.97 | $181.97 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $3,715.35
| Facility | | $1,479.11 | $2,290.87 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $4,073.80 / $4,466.84
| Professional | | $309.03 | $4,073.80 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $3,162.28 / $5,128.61
| Professional | | $288.40 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,467.37 / $6,918.31
| Facility | | $288.40 | $3,467.37 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $22,908.68
| Professional | | $3,162.28 | $4,570.88 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $8,511.38
| Facility | | $1,230.27 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $2,570.40 / $5,248.07
| Professional | | $239.88 | $2,570.40 | $5,248.07 |