- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,884.03 / $8,912.51
| Facility | | $501.19 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $426.58 / $812.83
| Professional | | $245.47 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $302.00 / $512.86 / $1,230.27
| Professional | 50 | $302.00 | $512.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,630.78 / $9,120.11
| Facility | | $1,479.11 | $3,630.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $776.25
| Professional | | $245.47 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.08 / $588.84 / $1,122.02
| Professional | 50 | $363.08 | $588.84 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $1,122.02 / $3,235.94
| Facility | | $50.12 | $1,122.02 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $489.78 / $1,122.02
| Professional | | $257.04 | $489.78 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,071.52 / $3,467.37
| Facility | | $229.09 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $758.58
| Professional | | $234.42 | $407.38 | $758.58 |