- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,162.28 / $10,471.29
| Facility | | $588.84 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $12,022.64
| Facility | 50 | $1,230.27 | $3,467.37 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $758.58 / $2,884.03
| Professional | | $288.40 | $758.58 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $794.33 / $5,011.87
| Professional | 50 | $371.54 | $794.33 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,762.47 / $14,454.40
| Facility | | $3,548.13 | $7,762.47 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,288.25 / $3,388.44
| Professional | | $331.13 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $478.63 / $2,041.74 / $4,677.35
| Professional | 50 | $478.63 | $2,041.74 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $4,073.80 / $12,589.25
| Facility | | $34.67 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,023.29 / $3,311.31
| Professional | | $331.13 | $1,023.29 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,096.48 / $3,019.95
| Professional | | $316.23 | $1,096.48 | $3,019.95 |