- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,142.11 / $12,309.30
| Facility | | $100.00 | $2,142.11 | $12,309.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.53 / $625.32 / $1,015.81
| Professional | | $115.53 | $625.32 | $1,015.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.13 / $413.20 / $1,519.29
| Professional | | $210.13 | $413.20 | $1,519.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $315.19 / $619.80 / $2,342.48
| Professional | 50 | $315.19 | $619.80 | $2,342.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.85 / $705.57 / $2,497.84
| Professional | | $348.85 | $705.57 | $2,497.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.95 / $677.18 / $2,709.45
| Professional | | $272.95 | $677.18 | $2,709.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.72 / $1,559.78 / $3,470.09
| Professional | | $1,216.72 | $1,559.78 | $3,470.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.52 / $715.27 / $1,044.53
| Professional | | $148.52 | $715.27 | $1,044.53 |