- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $7,762.47
| Facility | | $575.44 | $851.14 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,230.27
| Professional | | $446.68 | $645.65 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $60.26 / $602.56 / $1,737.80
| Professional | 50 | $60.26 | $602.56 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $10,232.93
| Facility | | $2,754.23 | $6,456.54 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $630.96 / $1,000.00
| Professional | | $416.87 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $630.96 / $912.01
| Professional | | $371.54 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $91.20 / $758.58
| Professional | | $32.36 | $91.20 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $1,148.15
| Facility | | $457.09 | $588.84 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $588.84 / $794.33
| Professional | | $331.13 | $588.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,025.60 / $10,471.29
| Facility | | $645.65 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $851.14
| Professional | | $457.09 | $616.60 | $851.14 |