- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,897.79 / $8,511.38
| Facility | | $912.01 | $4,897.79 | $8,511.38 |
- 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
- $416.87 / $478.63 / $1,000.00
| Professional | 50 | $416.87 | $478.63 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $933.25 / $1,202.26
| Professional | | $512.86 | $933.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $758.58 / $1,380.38 / $1,698.24
| Professional | 50 | $758.58 | $1,380.38 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $1,584.89
| Professional | | $426.58 | $794.33 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $724.44 / $977.24
| Professional | | $436.52 | $724.44 | $977.24 |
- 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 / $616.60 / $1,348.96
| Professional | | $446.68 | $616.60 | $1,348.96 |