- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,754.40 / $10,471.29
| Facility | | $2,754.23 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $870.96 / $2,238.72
| Professional | | $144.54 | $870.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | 50 | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $758.58 / $2,691.53
| Professional | | $165.96 | $758.58 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $1,096.48 / $1,737.80
| Professional | | $245.47 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $8,709.64
| Facility | | $3,467.37 | $5,495.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $776.25 / $1,995.26
| Professional | | $109.65 | $776.25 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,128.61 / $8,511.38
| Facility | | $2,511.89 | $5,128.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $588.84 / $1,819.70
| Professional | | $114.82 | $588.84 | $1,819.70 |