- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,248.07 / $10,232.93
| Facility | | $1,122.02 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,548.82 / $5,370.32 / $9,772.37
| Facility | 50 | $1,548.82 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $354.81 / $1,096.48
| Professional | | $177.83 | $354.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $48.98 / $616.60 / $3,467.37
| Professional | 50 | $48.98 | $616.60 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $100.00 / $138.04 / $3,890.45
| Professional | 50 | $100.00 | $138.04 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $489.78 / $1,047.13
| Professional | | $194.98 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $354.81 / $562.34
| Professional | | $288.40 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $16,595.87
| Facility | | $6,760.83 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $302.00 / $812.83
| Professional | | $141.25 | $302.00 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $562.34
| Professional | | $134.90 | $263.03 | $562.34 |