- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,492.63 / $7,395.31 / $11,709.00
| Facility | | $2,492.63 | $7,395.31 | $11,709.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,726.04 / $18,488.32 / $18,488.32
| Facility | 50 | $5,726.04 | $18,488.32 | $18,488.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.75 / $469.33 / $2,536.50
| Professional | | $334.75 | $469.33 | $2,536.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.17 / $1,357.17 / $1,611.36
| Professional | | $1,357.17 | $1,357.17 | $1,611.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.31 / $2,443.04 / $3,420.26
| Facility | | $503.31 | $2,443.04 | $3,420.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.84 / $2,679.60 / $3,379.59
| Professional | | $1,031.84 | $2,679.60 | $3,379.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.10 / $2,130.30 / $2,816.73
| Professional | | $1,709.10 | $2,130.30 | $2,816.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.31 / $2,443.04 / $3,420.26
| Facility | | $503.31 | $2,443.04 | $3,420.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.60 / $1,966.25 / $2,832.20
| Professional | | $749.60 | $1,966.25 | $2,832.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.09 / $1,944.71 / $3,222.70
| Professional | | $1,261.09 | $1,944.71 | $3,222.70 |