- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,365.16 / $10,964.78
| Facility | | $912.01 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $7,244.36 / $14,454.40
| Facility | 50 | $1,148.15 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,445.44
| Professional | | $501.19 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $12,302.69
| Facility | | $2,454.71 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $1,288.25
| Professional | | $467.74 | $660.69 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,479.11 / $4,073.80
| Facility | | $588.84 | $1,479.11 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $1,905.46
| Professional | | $457.09 | $794.33 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,174.90
| Professional | | $436.52 | $602.56 | $1,174.90 |