- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $9,549.93
| Facility | | $3,162.28 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,288.25 / $3,388.44
| Professional | | $870.96 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,862.09 / $2,511.89
| Professional | | $1,000.00 | $1,862.09 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,479.11 / $2,818.38 / $3,801.89
| Professional | 50 | $1,479.11 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,479.11 / $2,951.21
| Professional | | $831.76 | $1,479.11 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,122.02 / $1,584.89
| Professional | | $676.08 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $2,884.03
| Professional | | $870.96 | $1,122.02 | $2,884.03 |