- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,398.83 / $9,772.37
| Facility | | $891.25 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $707.95
| Professional | | $229.09 | $354.81 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $457.09 / $660.69
| Professional | | $239.88 | $457.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $707.95 / $1,000.00
| Professional | 50 | $354.81 | $707.95 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,096.48
| Professional | | $338.84 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $1,023.29
| Professional | | $288.40 | $501.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $1,047.13
| Professional | | $331.13 | $549.54 | $1,047.13 |