- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,754.40 / $10,471.29
| Facility | | $2,754.23 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,471.29 / $10,471.29 / $10,471.29
| Facility | 50 | $10,471.29 | $10,471.29 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $489.78
| Professional | | $138.04 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Professional | 50 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $549.54
| Professional | | $120.23 | $229.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $389.05
| Professional | | $213.80 | $295.12 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,244.36 / $11,748.98
| Facility | | $4,570.88 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $245.47 / $446.68
| Professional | | $123.03 | $245.47 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $10,964.78
| Facility | | $2,884.03 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $204.17 / $407.38
| Professional | | $114.82 | $204.17 | $407.38 |