- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,090.30 / $9,549.93
| Facility | | $524.81 | $3,090.30 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $11,220.18
| Facility | 50 | $1,819.70 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $645.65 / $1,698.24
| Professional | | $245.47 | $645.65 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $630.96 / $630.96 / $645.65
| Professional | 50 | $630.96 | $630.96 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,413.10 / $14,454.40
| Facility | | $2,951.21 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $812.83 / $2,041.74
| Professional | | $281.84 | $812.83 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $1,230.27 / $2,818.38
| Professional | 50 | $407.38 | $1,230.27 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,412.54 / $7,244.36
| Facility | | $269.15 | $1,412.54 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $741.31 / $1,995.26
| Professional | | $281.84 | $741.31 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,174.90 / $3,630.78
| Facility | | $275.42 | $1,174.90 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $707.95 / $1,778.28
| Professional | | $263.03 | $707.95 | $1,778.28 |