- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,370.32 / $14,125.38
| Facility | | $1,148.15 | $5,370.32 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $7,079.46
| Facility | 50 | $5,495.41 | $5,495.41 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $2,187.76 / $4,466.84
| Professional | | $162.18 | $2,187.76 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,943.28 / $16,982.44
| Facility | | $3,235.94 | $7,943.28 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $4,073.80
| Professional | | $144.54 | $245.47 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $204.17 / $338.84 / $4,570.88
| Professional | 50 | $204.17 | $338.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $7,762.47 / $21,379.62
| Facility | | $288.40 | $7,762.47 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $691.83 / $6,309.57
| Professional | | $190.55 | $691.83 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $2,187.76 / $5,623.41
| Professional | | $169.82 | $2,187.76 | $5,623.41 |