- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,162.28 / $6,025.60
| Facility | | $776.25 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 50 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $309.03 / $602.56
| Professional | | $173.78 | $309.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $398.11 / $398.11 / $1,905.46
| Professional | 50 | $398.11 | $398.11 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $302.00 / $478.63
| Professional | | $199.53 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $588.84
| Professional | | $32.36 | $33.11 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $6,760.83
| Facility | | $2,454.71 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,232.93
| Facility | 50 | $3,715.35 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $549.54
| Professional | | $239.88 | $363.08 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $616.60
| Professional | | $177.83 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $338.84 / $562.34
| Professional | | $213.80 | $338.84 | $562.34 |
- 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
- $165.96 / $257.04 / $489.78
| Professional | | $165.96 | $257.04 | $489.78 |