- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,548.13 / $5,888.44
| Facility | | $1,318.26 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,778.28 / $5,128.61 / $7,079.46
| Facility | 50 | $1,778.28 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $2,290.87
| Professional | | $363.08 | $549.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $616.60 / $1,230.27 / $1,479.11
| Professional | 50 | $616.60 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,000.00
| Professional | | $380.19 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,230.27
| Professional | | $32.36 | $33.11 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,388.44 / $7,585.78
| Facility | | $2,884.03 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,365.16 / $5,128.61 / $11,481.54
| Facility | 50 | $4,365.16 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $851.14 / $1,230.27
| Professional | | $691.83 | $851.14 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $954.99 / $1,258.93
| Professional | | $467.74 | $954.99 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,047.13
| Professional | | $575.44 | $724.44 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $7,079.46
| Facility | | $1,995.26 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $691.83
| Professional | | $363.08 | $457.09 | $691.83 |