- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $2,041.74
| Facility | | $1,412.54 | $1,905.46 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 50 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $151.36 / $316.23
| Professional | | $134.90 | $151.36 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $190.55
| Facility | | $158.49 | $158.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $2,290.87
| Facility | | $251.19 | $251.19 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $208.93 / $1,000.00
| Professional | | $125.89 | $208.93 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $9,332.54
| Facility | | $1,230.27 | $1,230.27 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $251.19
| Professional | | $114.82 | $165.96 | $251.19 |