- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,741.00 / $10,480.00 / $14,552.94
| Facility | | $3,741.00 | $10,480.00 | $14,552.94 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,609.27 / $4,609.27 / $8,366.58
| Facility | 50 | $4,609.27 | $4,609.27 | $8,366.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.88 / $320.54 / $1,281.78
| Professional | | $309.88 | $320.54 | $1,281.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $365.45 / $713.95 / $748.24
| Professional | 50 | $365.45 | $713.95 | $748.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.95 / $902.95 / $902.95
| Professional | | $902.95 | $902.95 | $902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.12 / $1,281.78 / $1,832.95
| Facility | | $330.12 | $1,281.78 | $1,832.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.28 / $1,665.30 / $2,167.75
| Professional | | $641.28 | $1,665.30 | $2,167.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.25 / $1,149.84 / $1,786.20
| Professional | | $991.25 | $1,149.84 | $1,786.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.12 / $1,281.78 / $1,832.95
| Facility | | $330.12 | $1,281.78 | $1,832.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.38 / $1,141.50 / $1,813.56
| Professional | | $363.38 | $1,141.50 | $1,813.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.90 / $722.36 / $1,660.92
| Professional | | $677.90 | $722.36 | $1,660.92 |