- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,202.26 / $7,244.36
| Facility | | $575.44 | $1,202.26 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $6,456.54
| Facility | 50 | $4,466.84 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $1,258.93
| Professional | | $457.09 | $676.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $588.84
| Professional | | $416.87 | $549.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $10,471.29
| Facility | | $2,344.23 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $1,000.00
| Professional | | $398.11 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $501.19 / $562.34
| Facility | | $478.63 | $501.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,412.54
| Facility | | $512.86 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $724.44 / $1,412.54
| Professional | | $446.68 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,025.60 / $10,715.19
| Facility | | $2,691.53 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $660.69 / $1,071.52
| Professional | | $457.09 | $660.69 | $1,071.52 |