- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $8,912.51 / $16,595.87
| Facility | | $912.01 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $4,168.69 / $6,165.95
| Facility | 50 | $1,862.09 | $4,168.69 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,318.26
| Professional | | $575.44 | $794.33 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $1,288.25 / $1,548.82
| Professional | 50 | $812.83 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Professional | 50 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,548.13 / $7,413.10
| Facility | | $1,621.81 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,202.26
| Professional | | $512.86 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,659.59
| Facility | | $707.95 | $707.95 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,479.11
| Professional | | $524.81 | $812.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,479.11
| Facility | | $575.44 | $851.14 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,964.78 / $16,982.44
| Facility | | $1,995.26 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,096.48
| Professional | | $512.86 | $676.08 | $1,096.48 |