- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $10,964.78
| Facility | | $2,951.21 | $6,309.57 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $3,019.95 / $6,606.93
| Professional | | $302.00 | $3,019.95 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Professional | 50 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $316.23
| Professional | | $295.12 | $295.12 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,000.00 / $10,000.00
| Professional | | $354.81 | $1,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $5,128.61 / $6,309.57
| Professional | | $512.86 | $5,128.61 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $32,359.37 / $57,543.99
| Facility | | $10,000.00 | $32,359.37 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $2,951.21 / $8,128.31
| Professional | | $245.47 | $2,951.21 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,715.19 / $29,512.09
| Facility | | $5,128.61 | $10,715.19 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $2,691.53 / $7,413.10
| Professional | | $288.40 | $2,691.53 | $7,413.10 |