- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $13,489.63
| Facility | | $10,964.78 | $10,964.78 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $1,621.81 / $3,090.30
| Professional | | $128.82 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | 50 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $257.04 / $2,041.74
| Professional | | $114.82 | $257.04 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $177.83 / $380.19 / $3,090.30
| Professional | 50 | $177.83 | $380.19 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $218.78 / $2,398.83
| Professional | | $151.36 | $218.78 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $1,202.26 / $2,454.71
| Professional | | $131.83 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $13,489.63
| Facility | | $10,964.78 | $10,964.78 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $1,479.11 / $2,630.27
| Professional | | $112.20 | $1,479.11 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | 50 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,412.54 / $2,630.27
| Professional | | $154.88 | $1,412.54 | $2,630.27 |