- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.11 / $6,341.27 / $10,062.44
| Facility | | $272.11 | $6,341.27 | $10,062.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.33 / $1,073.30 / $1,569.02
| Professional | | $282.33 | $1,073.30 | $1,569.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,454.26 / $1,454.26 / $1,454.26
| Professional | 50 | $1,454.26 | $1,454.26 | $1,454.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.85 / $696.08 / $2,182.19
| Professional | | $537.85 | $696.08 | $2,182.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $806.78 / $1,044.11 / $3,273.30
| Professional | 50 | $806.78 | $1,044.11 | $3,273.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.29 / $789.05 / $2,373.06
| Professional | | $377.29 | $789.05 | $2,373.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.11 / $1,824.61 / $5,086.20
| Facility | | $272.11 | $1,824.61 | $5,086.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.94 / $2,266.86 / $2,812.66
| Professional | | $1,327.94 | $2,266.86 | $2,812.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.66 / $2,271.51 / $2,812.66
| Professional | | $1,448.66 | $2,271.51 | $2,812.66 |