- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,290.87 / $4,073.80
| Facility | | $776.25 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $4,365.16
| Facility | 50 | $3,467.37 | $3,467.37 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $851.14
| Professional | | $363.08 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $363.08
| Professional | | $354.81 | $354.81 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,951.21 / $3,981.07
| Facility | | $1,548.82 | $2,951.21 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $933.25
| Professional | | $380.19 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $851.14
| Professional | | $363.08 | $524.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $28,840.32
| Facility | | $5,754.40 | $5,754.40 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,630.78 / $3,630.78
| Professional | | $3,162.28 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,630.78 / $6,309.57
| Facility | | $2,041.74 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $776.25
| Professional | | $363.08 | $457.09 | $776.25 |