- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.44 / $3,902.46 / $8,716.92
| Facility | | $915.44 | $3,902.46 | $8,716.92 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,709.91 / $6,477.47 / $8,311.70
| Facility | 50 | $3,709.91 | $6,477.47 | $8,311.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.93 / $534.16 / $1,106.24
| Professional | | $438.93 | $534.16 | $1,106.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,780.00 / $9,729.00
| Facility | | $2,740.00 | $4,780.00 | $9,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.86 / $622.87 / $1,043.46
| Professional | | $490.86 | $622.87 | $1,043.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.91 / $1,361.02 / $2,006.50
| Facility | | $1,064.91 | $1,361.02 | $2,006.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.15 / $712.05 / $1,126.39
| Professional | | $513.15 | $712.05 | $1,126.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.01 / $641.84 / $1,144.61
| Professional | | $452.01 | $641.84 | $1,144.61 |