- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,288.25 / $1,995.26
| Facility | | $549.54 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $676.08 / $2,398.83
| Professional | | $147.91 | $676.08 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $1,288.25
| Professional | | $1,000.00 | $1,148.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | 50 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,754.40 / $5,754.40
| Facility | | $4,073.80 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Professional | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $954.99 / $3,090.30
| Professional | | $165.96 | $954.99 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,621.81 / $4,168.69
| Facility | | $630.96 | $1,621.81 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $1,479.11 / $3,388.44
| Professional | | $162.18 | $1,479.11 | $3,388.44 |