- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,238.72 / $7,943.28
| Facility | | $177.83 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $794.33 / $2,951.21 / $5,754.40
| Facility | 50 | $794.33 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $169.82 / $478.63
| Professional | | $63.10 | $169.82 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $204.17 / $501.19
| Professional | | $70.79 | $204.17 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $257.04 / $2,398.83
| Facility | | $67.61 | $257.04 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $186.21 / $602.56
| Professional | | $74.13 | $186.21 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,905.46 / $4,677.35
| Facility | | $537.03 | $1,905.46 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $165.96 / $416.87
| Professional | | $64.57 | $165.96 | $416.87 |