- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,888.44 / $10,964.78
| Facility | | $2,290.87 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | 50 | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $162.18 / $575.44
| Professional | | $102.33 | $162.18 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $537.03 / $691.83 / $1,023.29
| Professional | 50 | $537.03 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $218.78 / $549.54
| Professional | | $120.23 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $194.98 / $269.15
| Professional | | $147.91 | $194.98 | $269.15 |
- 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
- $87.10 / $186.21 / $616.60
| Professional | | $87.10 | $186.21 | $616.60 |
- 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
- $89.13 / $165.96 / $346.74
| Professional | | $89.13 | $165.96 | $346.74 |