- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.65 / $5,339.78 / $9,170.17
| Facility | | $2,545.65 | $5,339.78 | $9,170.17 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,905.79 / $8,905.79 / $10,777.80
| Facility | 50 | $8,905.79 | $8,905.79 | $10,777.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.06 / $2,036.52 / $2,794.59
| Professional | | $368.06 | $2,036.52 | $2,794.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.75 / $1,379.48 / $1,928.73
| Professional | | $1,044.75 | $1,379.48 | $1,928.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.17 / $2,036.52 / $2,898.10
| Facility | | $416.17 | $2,036.52 | $2,898.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.88 / $1,331.37 / $2,702.84
| Professional | | $1,090.88 | $1,331.37 | $2,702.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.40 / $2,102.90 / $2,576.69
| Professional | | $1,379.40 | $2,102.90 | $2,576.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.17 / $2,036.52 / $2,898.10
| Facility | | $416.17 | $2,036.52 | $2,898.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.40 / $2,131.80 / $2,819.69
| Professional | | $862.40 | $2,131.80 | $2,819.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.30 / $1,685.56 / $2,541.86
| Professional | | $1,117.30 | $1,685.56 | $2,541.86 |