- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $8,511.38
| Facility | | $2,290.87 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $1,412.54 / $2,344.23
| Professional | | $57.54 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $162.18 / $3,019.95
| Professional | | $77.62 | $162.18 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.82 / $234.42 / $2,344.23
| Professional | 50 | $114.82 | $234.42 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $1,148.15 / $3,388.44
| Professional | | $64.57 | $1,148.15 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,584.89 / $2,511.89
| Professional | | $954.99 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $1,819.70
| Professional | | $1,000.00 | $1,778.28 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $2,454.71
| Professional | | $56.23 | $1,096.48 | $2,454.71 |