- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,630.27 / $6,456.54
| Facility | | $1,096.48 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $933.25
| Professional | | $398.11 | $588.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $77.62 / $776.25 / $3,019.95
| Professional | 50 | $77.62 | $776.25 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,019.95 / $4,265.80
| Facility | | $1,659.59 | $3,019.95 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $1,071.52
| Professional | | $436.52 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $933.25
| Professional | | $407.38 | $588.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $33,884.42
| Facility | | $5,754.40 | $5,754.40 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Professional | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,630.78 / $6,309.57
| Facility | | $2,041.74 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $851.14
| Professional | | $398.11 | $524.81 | $851.14 |