- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,801.89 / $7,585.78
| Facility | | $467.74 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $1,174.90
| Professional | | $302.00 | $478.63 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $3,311.31 / $3,311.31
| Professional | 50 | $1,862.09 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $17,378.01
| Facility | | $4,570.88 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $831.76
| Professional | | $316.23 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $691.83 / $1,148.15 / $1,621.81
| Professional | 50 | $691.83 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $891.25
| Professional | | $407.38 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,659.59
| Professional | | $346.74 | $602.56 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $407.38 / $426.58
| Professional | | $245.47 | $407.38 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,128.31 / $16,595.87
| Facility | | $3,548.13 | $8,128.31 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $1,148.15
| Professional | | $416.87 | $645.65 | $1,148.15 |