- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,162.28 / $4,786.30
| Facility | | $741.31 | $3,162.28 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,235.94 / $4,897.79 / $7,079.46
| Facility | 50 | $3,235.94 | $4,897.79 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $389.05 / $630.96
| Professional | | $223.87 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $645.65 / $724.44 / $933.25
| Professional | 50 | $645.65 | $724.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $645.65
| Professional | | $208.93 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $724.44
| Professional | | $32.36 | $33.11 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,890.45 / $8,912.51
| Facility | | $3,311.31 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,011.87 / $5,888.44 / $13,489.63
| Facility | 50 | $5,011.87 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $912.01
| Professional | | $309.03 | $537.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $446.68 / $776.25
| Professional | | $245.47 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $501.19 / $1,202.26
| Professional | | $269.15 | $501.19 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $7,079.46
| Facility | | $1,995.26 | $5,128.61 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $562.34
| Professional | | $204.17 | $354.81 | $562.34 |