- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.86 / $2,644.86 / $5,519.00
| Facility | | $608.86 | $2,644.86 | $5,519.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,425.70 / $4,425.70 / $5,501.21
| Facility | 50 | $4,425.70 | $4,425.70 | $5,501.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.31 / $511.18 / $682.97
| Professional | | $296.31 | $511.18 | $682.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $810.17 / $810.17 / $810.17
| Professional | 50 | $810.17 | $810.17 | $810.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.77 / $528.14 / $658.41
| Professional | | $397.77 | $528.14 | $658.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.73 / $528.24 / $745.29
| Facility | | $331.73 | $528.24 | $745.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.73 / $560.88 / $743.32
| Professional | | $462.73 | $560.88 | $743.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $529.36 / $665.96
| Professional | | $32.34 | $529.36 | $665.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,749.17 / $3,789.62 / $4,803.78
| Facility | | $2,749.17 | $3,789.62 | $4,803.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,936.62 / $5,684.43 / $7,560.99
| Facility | 50 | $3,936.62 | $5,684.43 | $7,560.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.47 / $469.05 / $625.13
| Professional | | $443.47 | $469.05 | $625.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,550.00 / $12,152.00 / $12,233.00
| Facility | | $5,550.00 | $12,152.00 | $12,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.41 / $535.04 / $792.88
| Professional | | $378.41 | $535.04 | $792.88 |