- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,754.40 / $10,471.29
| Facility | | $2,754.23 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $1,148.15
| Professional | | $436.52 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | 50 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,513.56
| Professional | | $371.54 | $588.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $954.99
| Professional | | $524.81 | $724.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,585.78 / $11,748.98
| Facility | | $4,677.35 | $7,585.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,148.15
| Professional | | $380.19 | $676.08 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $10,964.78
| Facility | | $2,884.03 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $1,023.29
| Professional | | $363.08 | $537.03 | $1,023.29 |