- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $5,011.87 / $5,495.41
| Facility | | $457.09 | $5,011.87 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $213.80 / $426.58 / $2,754.23
| Professional | 50 | $213.80 | $426.58 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,456.54 / $14,791.08
| Facility | | $2,290.87 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,585.78 / $13,803.84 / $34,673.69
| Facility | 50 | $7,585.78 | $13,803.84 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $933.25 / $1,380.38 / $2,238.72
| Professional | 50 | $933.25 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $3,715.35
| Facility | | $1,122.02 | $1,584.89 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,513.56 / $2,951.21
| Facility | | $1,202.26 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $870.96 / $7,762.47
| Facility | | $467.74 | $870.96 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.55 / $2,089.30 / $4,677.35
| Facility | 50 | $0.55 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $8,912.51
| Facility | | $1,584.89 | $5,248.07 | $8,912.51 |