- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,025.60 / $10,964.78
| Facility | | $2,570.40 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $3,311.31 / $15,848.93
| Facility | 50 | $812.83 | $3,311.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $457.09 / $851.14
| Professional | | $245.47 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $562.34 / $1,071.52
| Professional | 50 | $354.81 | $562.34 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $16,218.10 / $19,952.62
| Facility | | $5,370.32 | $16,218.10 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $707.95
| Professional | | $316.23 | $537.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $457.09 / $776.25 / $1,047.13
| Professional | 50 | $457.09 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $1,047.13
| Professional | | $331.13 | $524.81 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $870.96
| Professional | | $436.52 | $436.52 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,079.46 / $11,220.18
| Facility | | $4,570.88 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $467.74 / $1,047.13
| Professional | | $257.04 | $467.74 | $1,047.13 |