- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,370.32 / $7,413.10
| Facility | | $2,041.74 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,380.38 / $1,778.28 / $5,623.41
| Facility | 50 | $1,380.38 | $1,778.28 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $1,513.56 / $3,388.44
| Professional | | $144.54 | $1,513.56 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $389.05 / $5,128.61 / $5,370.32
| Professional | 50 | $389.05 | $5,128.61 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,677.35 / $9,772.37
| Facility | | $1,995.26 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $1,548.82 / $5,623.41
| Professional | | $208.93 | $1,548.82 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $316.23 / $2,344.23 / $8,709.64
| Professional | 50 | $316.23 | $2,344.23 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $407.38 / $4,265.80
| Professional | | $204.17 | $407.38 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $1,584.89 / $3,019.95
| Professional | | $125.89 | $1,584.89 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,168.69 / $6,918.31
| Facility | | $1,202.26 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $1,737.80 / $5,370.32
| Professional | | $162.18 | $1,737.80 | $5,370.32 |