- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,754.39 / $6,513.38 / $10,672.32
| Facility | | $1,754.39 | $6,513.38 | $10,672.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,008.80 / $2,008.80 / $8,960.79
| Facility | 50 | $2,008.80 | $2,008.80 | $8,960.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.16 / $2,256.30 / $4,732.20
| Professional | | $606.16 | $2,256.30 | $4,732.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.40 / $1,650.40 / $1,650.40
| Facility | | $1,650.40 | $1,650.40 | $1,650.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,483.00 / $2,387.00
| Professional | | $1,236.00 | $1,483.00 | $2,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.72 / $1,207.86 / $1,549.94
| Professional | | $752.72 | $1,207.86 | $1,549.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.86 / $1,028.41 / $1,946.11
| Professional | | $839.86 | $1,028.41 | $1,946.11 |