- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,801.89 / $12,589.25
| Facility | | $602.56 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $724.44
| Professional | | $275.42 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | 50 | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $229.09 / $302.00
| Professional | | $165.96 | $229.09 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $1,905.46
| Facility | | $758.58 | $1,174.90 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $524.81 / $575.44
| Professional | | $323.59 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $524.81 / $1,000.00
| Professional | | $275.42 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,230.27 / $6,606.93
| Facility | | $346.74 | $1,230.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $3,630.78
| Professional | | $389.05 | $549.54 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,265.80 / $8,128.31
| Facility | | $1,230.27 | $4,265.80 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $724.44
| Professional | | $245.47 | $446.68 | $724.44 |