- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.54 / $342.29 / $3,865.28
| Facility | | $330.54 | $342.29 | $3,865.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.16 / $1,083.45 / $5,072.25
| Professional | | $331.16 | $1,083.45 | $5,072.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.46 / $1,923.70 / $6,709.71
| Professional | | $361.46 | $1,923.70 | $6,709.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.94 / $3,438.67 / $4,101.89
| Facility | | $255.94 | $3,438.67 | $4,101.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $616.74 / $5,197.38 / $5,939.86
| Facility | 50 | $616.74 | $5,197.38 | $5,939.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,464.92 / $3,464.92 / $3,464.92
| Professional | | $3,464.92 | $3,464.92 | $3,464.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.52 / $1,732.88 / $2,127.48
| Professional | | $307.52 | $1,732.88 | $2,127.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,965.44 / $3,310.24 / $5,379.06
| Professional | | $1,965.44 | $3,310.24 | $5,379.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,213.69 / $2,213.69
| Facility | | $55.00 | $2,213.69 | $2,213.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,773.74 / $7,773.74 / $13,145.81
| Professional | | $7,773.74 | $7,773.74 | $13,145.81 |