- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.25 / $3,008.00 / $7,960.15
| Facility | | $1,337.25 | $3,008.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,682.25 / $9,390.06 / $15,971.40
| Facility | 50 | $1,682.25 | $9,390.06 | $15,971.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.51 / $1,259.41 / $2,165.19
| Professional | | $278.51 | $1,259.41 | $2,165.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,086.47 / $2,355.91 / $6,129.60
| Professional | 50 | $1,086.47 | $2,355.91 | $6,129.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.21 / $356.81 / $1,559.63
| Professional | | $144.21 | $356.81 | $1,559.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $471.75 / $471.75 / $471.75
| Professional | 50 | $471.75 | $471.75 | $471.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.20 / $314.82 / $518.16
| Facility | | $79.20 | $314.82 | $518.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.76 / $1,136.83 / $1,860.26
| Professional | | $323.76 | $1,136.83 | $1,860.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.72 / $558.72 / $558.72
| Facility | | $558.72 | $558.72 | $558.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.92 / $1,368.82 / $2,914.79
| Professional | | $338.92 | $1,368.82 | $2,914.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.03 / $1,703.16 / $3,672.62
| Facility | | $339.03 | $1,703.16 | $3,672.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.79 / $2,177.33 / $12,114.16
| Professional | | $1,505.79 | $2,177.33 | $12,114.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,899.00 / $11,396.00
| Facility | | $5,255.00 | $7,899.00 | $11,396.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.33 / $1,751.60 / $3,342.96
| Professional | | $1,441.33 | $1,751.60 | $3,342.96 |