- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $4,570.88
| Facility | | $2,089.30 | $3,981.07 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $1,258.93 / $2,884.03
| Facility | 50 | $812.83 | $1,258.93 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $371.54 / $1,000.00
| Professional | | $204.17 | $371.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $117.49 / $346.74 / $1,778.28
| Professional | 50 | $117.49 | $346.74 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $245.47 / $489.78
| Professional | | $158.49 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $363.08 / $707.95
| Professional | | $138.04 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $354.81 / $691.83
| Professional | | $186.21 | $354.81 | $691.83 |