- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $5,011.87 / $11,748.98
| Facility | | $724.44 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $7,079.46 / $18,197.01
| Facility | 50 | $3,090.30 | $7,079.46 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $1,445.44
| Professional | | $407.38 | $588.84 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,791.08
| Facility | | $2,818.38 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $1,202.26
| Professional | | $426.58 | $645.65 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,949.84 / $12,302.69
| Facility | | $794.33 | $1,949.84 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $1,584.89
| Professional | | $457.09 | $741.31 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,471.29
| Facility | | $1,584.89 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,148.15
| Professional | | $398.11 | $602.56 | $1,148.15 |