- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,888.44 / $10,471.29
| Facility | | $3,467.37 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $446.68 / $1,096.48
| Professional | | $169.82 | $446.68 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Professional | 50 | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $549.54 / $1,318.26
| Professional | | $204.17 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $616.60 / $977.24
| Professional | | $288.40 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,748.98 / $18,620.87
| Facility | | $7,413.10 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $512.86 / $1,000.00
| Professional | | $141.25 | $512.86 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $10,964.78
| Facility | | $2,884.03 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $389.05 / $912.01
| Professional | | $138.04 | $389.05 | $912.01 |