- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,570.88 / $8,912.51
| Facility | | $1,778.28 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $9,549.93
| Facility | 50 | $1,819.70 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $1,318.26
| Professional | | $199.53 | $446.68 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $323.59 / $707.95 / $2,951.21
| Professional | 50 | $323.59 | $707.95 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $446.68 / $645.65
| Professional | | $218.78 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $331.13 / $645.65 / $912.01
| Professional | 50 | $331.13 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,511.89 / $3,235.94
| Facility | | $851.14 | $2,511.89 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $562.34 / $1,047.13
| Professional | | $316.23 | $562.34 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,174.90
| Professional | | $478.63 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $446.68 / $1,047.13
| Professional | | $229.09 | $446.68 | $1,047.13 |