- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,570.88 / $12,882.50
| Facility | | $812.83 | $4,570.88 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,801.89 / $15,488.17 / $32,359.37
| Facility | 50 | $3,801.89 | $15,488.17 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,479.11 / $5,248.07
| Professional | | $436.52 | $1,479.11 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $11,481.54 / $26,915.35
| Facility | | $4,677.35 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,454.71 / $6,456.54
| Professional | | $457.09 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $9,772.37 / $24,547.09
| Facility | | $741.31 | $9,772.37 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,862.09 / $7,585.78
| Professional | | $524.81 | $1,862.09 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,481.54 / $30,199.52
| Facility | | $3,630.78 | $11,481.54 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $2,454.71 / $6,165.95
| Professional | | $467.74 | $2,454.71 | $6,165.95 |