- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,888.44 / $10,471.29
| Facility | | $1,445.44 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,630.27 / $8,511.38 / $9,120.11
| Facility | 50 | $2,630.27 | $8,511.38 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $2,630.27
| Professional | | $602.56 | $870.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $5,495.41
| Professional | 50 | $1,071.52 | $2,041.74 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $1,513.56
| Professional | | $691.83 | $1,202.26 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $2,137.96
| Professional | 50 | $1,047.13 | $1,778.28 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $933.25 / $1,995.26
| Professional | | $537.03 | $933.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $933.25 / $1,258.93
| Professional | | $549.54 | $933.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,737.80
| Professional | | $537.03 | $776.25 | $1,737.80 |