- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,888.44 / $10,471.29
| Facility | | $1,230.27 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,258.93
| Professional | | $457.09 | $691.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | 50 | $616.60 | $616.60 | $616.60 |
- 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
- $588.84 / $933.25 / $1,288.25
| Professional | | $588.84 | $933.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $831.76 / $1,380.38 / $1,659.59
| Professional | 50 | $831.76 | $1,380.38 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $831.76 / $1,698.24
| Professional | | $416.87 | $831.76 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,000.00
| Professional | | $467.74 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,348.96
| Professional | | $446.68 | $645.65 | $1,348.96 |