- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $10,715.19
| Facility | | $1,778.28 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 50 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $134.90 / $346.74
| Professional | | $75.86 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $346.74 / $524.81
| Professional | 50 | $199.53 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $169.82 / $436.52
| Professional | | $91.20 | $169.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $181.97 / $251.19
| Professional | | $123.03 | $181.97 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $3,548.13
| Facility | | $1,412.54 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $141.25 / $467.74
| Professional | | $60.26 | $141.25 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,630.78 / $7,762.47
| Facility | | $1,862.09 | $3,630.78 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $131.83 / $288.40
| Professional | | $66.07 | $131.83 | $288.40 |