- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.28 / $2,957.00 / $6,244.44
| Facility | | $1,017.28 | $2,957.00 | $6,244.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,867.32 / $2,867.32 / $6,397.68
| Facility | 50 | $2,867.32 | $2,867.32 | $6,397.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.98 / $370.52 / $696.16
| Professional | | $126.98 | $370.52 | $696.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.87 / $289.04 / $807.95
| Professional | | $169.87 | $289.04 | $807.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.53 / $692.94 / $1,022.09
| Professional | | $203.53 | $692.94 | $1,022.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,771.10 / $2,771.10 / $2,771.10
| Facility | | $2,771.10 | $2,771.10 | $2,771.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.73 / $430.69 / $923.59
| Professional | | $186.73 | $430.69 | $923.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.66 / $2,900.92 / $7,289.07
| Facility | | $1,433.66 | $2,900.92 | $7,289.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,867.32 / $2,867.32 / $6,397.68
| Facility | 50 | $2,867.32 | $2,867.32 | $6,397.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.98 / $370.52 / $755.01
| Professional | | $126.98 | $370.52 | $755.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.78 / $916.23 / $1,105.79
| Professional | | $671.78 | $916.23 | $1,105.79 |