- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,025.60 / $18,197.01
| Facility | | $1,819.70 | $6,025.60 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | 50 | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $1,174.90
| Professional | | $323.59 | $512.86 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $575.44 / $2,137.96
| Professional | 50 | $575.44 | $575.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $691.83
| Professional | | $245.47 | $446.68 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $660.69 / $1,023.29
| Professional | 50 | $371.54 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $776.25
| Professional | | $346.74 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $794.33
| Professional | | $302.00 | $512.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,025.60 / $18,197.01
| Facility | | $1,819.70 | $6,025.60 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | 50 | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $933.25
| Professional | | $363.08 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $575.44 / $575.44 / $2,137.96
| Professional | 50 | $575.44 | $575.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $1,000.00
| Professional | | $363.08 | $645.65 | $1,000.00 |