- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $758.58 / $8,511.38
| Facility | | $295.12 | $758.58 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $758.58 / $1,258.93
| Professional | | $302.00 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $2,344.23
| Professional | 50 | $1,380.38 | $1,380.38 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,778.28
| Professional | | $588.84 | $851.14 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $870.96 / $1,258.93 / $2,691.53
| Professional | 50 | $870.96 | $1,258.93 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $933.25 / $1,949.84
| Professional | | $436.52 | $933.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $758.58 / $2,290.87
| Facility | | $302.00 | $758.58 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,412.54 / $2,754.23
| Professional | | $776.25 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $12,022.64 / $12,302.69
| Facility | | $10,715.19 | $12,022.64 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $776.25 / $1,659.59
| Professional | | $363.08 | $776.25 | $1,659.59 |