- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,466.84 / $7,413.10
| Facility | | $1,202.26 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 50 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $275.42 / $467.74
| Professional | | $144.54 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $933.25 / $1,000.00 / $2,818.38
| Professional | 50 | $933.25 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | 50 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,818.38 / $4,786.30
| Facility | | $1,071.52 | $2,818.38 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $446.68
| Professional | | $181.97 | $263.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $398.11 / $660.69
| Professional | 50 | $281.84 | $398.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $338.84 / $645.65
| Professional | | $194.98 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $295.12 / $549.54
| Professional | | $131.83 | $295.12 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,090.30 / $5,370.32
| Facility | | $562.34 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $537.03
| Professional | | $154.88 | $281.84 | $537.03 |