- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.33 / $6,451.83 / $14,507.68
| Facility | | $266.33 | $6,451.83 | $14,507.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,310.53 / $6,807.23 / $21,031.29
| Facility | 50 | $3,310.53 | $6,807.23 | $21,031.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.35 / $261.98 / $309.88
| Professional | | $254.35 | $261.98 | $309.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $365.45 / $713.95 / $748.24
| Professional | 50 | $365.45 | $713.95 | $748.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.01 / $392.34 / $468.66
| Professional | | $240.01 | $392.34 | $468.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,739.09 / $1,739.09 / $14,308.52
| Facility | | $1,739.09 | $1,739.09 | $14,308.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,101.26 / $2,101.26 / $8,169.55
| Facility | 50 | $2,101.26 | $2,101.26 | $8,169.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.74 / $386.45 / $601.14
| Professional | | $252.74 | $386.45 | $601.14 |