- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,073.80 / $11,748.98
| Facility | | $691.83 | $4,073.80 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,818.38 / $7,244.36 / $15,488.17
| Facility | 50 | $2,818.38 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $707.95 / $1,737.80
| Professional | | $295.12 | $707.95 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $512.86 / $1,202.26 / $3,162.28
| Professional | 50 | $512.86 | $1,202.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,079.46 / $28,840.32
| Facility | | $3,162.28 | $7,079.46 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $1,148.15
| Professional | | $338.84 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $489.78 / $812.83 / $1,621.81
| Professional | 50 | $489.78 | $812.83 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,754.23 / $13,182.57
| Facility | | $512.86 | $2,754.23 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $812.83 / $1,949.84
| Professional | | $354.81 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $27,542.29
| Facility | | $3,019.95 | $8,912.51 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $676.08 / $1,584.89
| Professional | | $295.12 | $676.08 | $1,584.89 |