- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.25 / $3,975.93 / $9,243.37
| Facility | | $977.25 | $3,975.93 | $9,243.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,375.00 / $6,106.50 / $8,416.50
| Facility | 50 | $3,375.00 | $6,106.50 | $8,416.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.93 / $534.16 / $672.41
| Professional | | $438.93 | $534.16 | $672.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.50 / $446.12 / $642.99
| Professional | | $321.50 | $446.12 | $642.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,602.87 / $8,785.64 / $13,706.31
| Facility | | $5,602.87 | $8,785.64 | $13,706.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.55 / $655.55 / $690.70
| Professional | | $487.55 | $655.55 | $690.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.71 / $643.83 / $827.87
| Professional | | $510.71 | $643.83 | $827.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.17 / $740.30 / $7,214.89
| Facility | | $534.17 | $740.30 | $7,214.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,899.35 / $2,899.35 / $2,899.35
| Facility | 50 | $2,899.35 | $2,899.35 | $2,899.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.02 / $565.87 / $3,839.44
| Professional | | $448.02 | $565.87 | $3,839.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.13 / $530.16 / $759.33
| Professional | | $424.13 | $530.16 | $759.33 |