- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,884.03 / $4,570.88
| Facility | | $912.01 | $2,884.03 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $912.01
| Professional | | $251.19 | $588.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $1,023.29
| Professional | | $316.23 | $537.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,288.25
| Professional | | $32.36 | $33.11 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,025.60 / $13,489.63
| Facility | | $5,128.61 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,585.78 / $8,912.51 / $20,417.38
| Facility | 50 | $7,585.78 | $8,912.51 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $1,071.52
| Professional | | $371.54 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $602.56 / $1,548.82
| Professional | | $275.42 | $602.56 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $794.33 / $1,230.27
| Professional | | $354.81 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $7,079.46
| Facility | | $1,995.26 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $512.86 / $1,000.00
| Professional | | $263.03 | $512.86 | $1,000.00 |