- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,162.28 / $6,918.31
| Facility | | $1,995.26 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 50 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $467.74 / $1,258.93
| Professional | | $141.25 | $467.74 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $537.03 / $954.99
| Professional | | $190.55 | $537.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $467.74
| Professional | | $32.36 | $33.11 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $6,309.57
| Facility | | $2,344.23 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $4,073.80 / $9,549.93
| Facility | 50 | $3,467.37 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $371.54 / $1,318.26
| Professional | | $218.78 | $371.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $501.19 / $1,288.25
| Professional | | $162.18 | $501.19 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $645.65 / $933.25
| Professional | | $208.93 | $645.65 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,466.84 / $5,128.61
| Facility | | $1,698.24 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $467.74 / $1,071.52
| Professional | | $154.88 | $467.74 | $1,071.52 |