- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $5,011.87 / $15,488.17
| Facility | | $741.31 | $5,011.87 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $11,748.98 / $37,153.52
| Facility | 50 | $4,168.69 | $11,748.98 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,548.82 / $6,918.31
| Professional | | $309.03 | $1,548.82 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $501.19 / $870.96 / $7,762.47
| Professional | 50 | $501.19 | $870.96 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $11,481.54 / $26,915.35
| Facility | | $4,570.88 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $3,311.31 / $8,128.31
| Professional | | $316.23 | $3,311.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $4,897.79 / $10,471.29
| Professional | 50 | $446.68 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $12,302.69 / $30,902.95
| Facility | | $512.86 | $12,302.69 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,348.96 / $9,332.54
| Professional | | $363.08 | $1,348.96 | $9,332.54 |
- 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
- $323.59 / $2,630.27 / $6,918.31
| Professional | | $323.59 | $2,630.27 | $6,918.31 |