- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,890.45 / $10,715.19
| Facility | | $575.44 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,454.71 / $4,786.30 / $8,511.38
| Facility | 50 | $2,454.71 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $851.14
| Professional | | $295.12 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $181.97 / $234.42 / $281.84
| Professional | 50 | $181.97 | $234.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,025.60 / $12,302.69
| Facility | | $2,041.74 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $831.76
| Professional | | $269.15 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $389.05 / $630.96 / $1,230.27
| Professional | 50 | $389.05 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,513.56 / $3,630.78
| Facility | | $512.86 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $524.81 / $1,288.25
| Professional | | $288.40 | $524.81 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,168.69 / $9,549.93
| Facility | | $1,412.54 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $416.87 / $831.76
| Professional | | $263.03 | $416.87 | $831.76 |