- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.15 / $6,486.25 / $13,413.92
| Facility | | $1,199.15 | $6,486.25 | $13,413.92 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,603.20 / $4,603.20 / $5,098.06
| Facility | 50 | $4,603.20 | $4,603.20 | $5,098.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.13 / $562.49 / $1,980.99
| Professional | | $210.13 | $562.49 | $1,980.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $7,958.75 / $7,958.75 / $7,958.75
| Professional | 50 | $7,958.75 | $7,958.75 | $7,958.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.11 / $814.11 / $1,899.69
| Professional | | $571.11 | $814.11 | $1,899.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.27 / $1,033.55 / $2,773.39
| Facility | | $281.27 | $1,033.55 | $2,773.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.60 / $1,055.58 / $2,513.55
| Professional | | $466.60 | $1,055.58 | $2,513.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.25 / $1,306.00 / $2,370.00
| Professional | | $721.25 | $1,306.00 | $2,370.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.27 / $1,033.55 / $2,773.39
| Facility | | $281.27 | $1,033.55 | $2,773.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.78 / $1,242.59 / $2,370.00
| Professional | | $564.78 | $1,242.59 | $2,370.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.70 / $1,125.54 / $2,405.08
| Professional | | $1,055.70 | $1,125.54 | $2,405.08 |