- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,466.84 / $10,964.78
| Facility | | $1,230.27 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $933.25 / $5,754.40 / $16,218.10
| Facility | 50 | $933.25 | $5,754.40 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $2,754.23
| Professional | | $812.83 | $1,148.15 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $6,918.31
| Professional | 50 | $1,230.27 | $1,479.11 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,791.08
| Facility | | $2,754.23 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,344.23
| Professional | | $831.76 | $1,174.90 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $3,388.44
| Professional | 50 | $1,202.26 | $1,698.24 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,290.87 / $7,762.47
| Facility | | $891.25 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,412.54 / $3,467.37
| Professional | | $831.76 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $12,589.25
| Facility | | $1,819.70 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $2,041.74
| Professional | | $776.25 | $1,071.52 | $2,041.74 |