- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,698.24 / $3,715.35
| Facility | | $1,047.13 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $676.08 / $3,311.31
| Professional | | $281.84 | $676.08 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $489.78 / $1,000.00 / $4,570.88
| Professional | 50 | $489.78 | $1,000.00 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,311.31 / $4,365.16
| Facility | | $2,951.21 | $3,311.31 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $741.31 / $1,995.26
| Professional | | $288.40 | $741.31 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $977.24 / $3,235.94
| Professional | | $331.13 | $977.24 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $660.69 / $3,090.30
| Professional | | $316.23 | $660.69 | $3,090.30 |