- 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
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | 50 | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $190.55 / $331.13
| Professional | | $125.89 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $100.00 / $346.74 / $891.25
| Professional | 50 | $100.00 | $346.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $218.78 / $512.86
| Professional | | $107.15 | $218.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $263.03
| Professional | | $144.54 | $194.98 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,513.56
| Facility | | $602.56 | $912.01 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $186.21 / $426.58
| Professional | | $104.71 | $186.21 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $316.23
| Professional | | $97.72 | $169.82 | $316.23 |