- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,467.37 / $9,120.11
| Facility | | $758.58 | $3,467.37 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,412.54 / $2,754.23
| Professional | | $154.88 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,019.95 / $11,220.18 / $12,022.64
| Professional | 50 | $3,019.95 | $11,220.18 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,365.16 / $10,232.93
| Facility | | $1,659.59 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,445.44 / $3,090.30
| Professional | | $154.88 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $234.42 / $2,089.30 / $4,265.80
| Professional | 50 | $234.42 | $2,089.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $3,162.28 / $10,232.93
| Facility | | $162.18 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $707.95 / $3,801.89
| Professional | | $177.83 | $707.95 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,258.93 / $3,162.28
| Professional | | $158.49 | $1,258.93 | $3,162.28 |