- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,244.36 / $11,481.54
| Facility | | $3,981.07 | $7,244.36 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | 50 | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $3,019.95 / $5,754.40
| Professional | | $245.47 | $3,019.95 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $2,398.83 / $9,772.37
| Professional | | $281.84 | $2,398.83 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $3,630.78 / $5,623.41
| Professional | | $407.38 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $22,387.21 / $35,481.34
| Facility | | $14,454.40 | $22,387.21 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $3,388.44 / $7,585.78
| Professional | | $204.17 | $3,388.44 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,585.78 / $15,135.61
| Facility | | $3,467.37 | $7,585.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $1,949.84 / $6,760.83
| Professional | | $190.55 | $1,949.84 | $6,760.83 |