- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,265.80 / $11,481.54
| Facility | | $645.65 | $4,265.80 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $12,022.64
| Facility | 50 | $2,818.38 | $7,079.46 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $1,513.56
| Professional | | $467.74 | $602.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $691.83 / $1,230.27 / $3,388.44
| Professional | 50 | $691.83 | $1,230.27 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,370.32 / $12,022.64
| Facility | | $2,398.83 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $724.44 / $1,288.25
| Professional | | $501.19 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,905.46
| Professional | 50 | $741.31 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,238.72 / $5,623.41
| Facility | | $912.01 | $2,238.72 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $1,659.59
| Professional | | $512.86 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $1,202.26
| Professional | | $457.09 | $645.65 | $1,202.26 |