- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,495.41 / $9,549.93
| Facility | | $912.01 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,023.29 / $2,290.87 / $7,943.28
| Facility | 50 | $1,023.29 | $2,290.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $165.96 / $371.54
| Professional | | $138.04 | $165.96 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $281.84 / $346.74
| Professional | | $128.82 | $281.84 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $380.19
| Professional | | $173.78 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $275.42
| Professional | | $269.15 | $269.15 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $416.87
| Professional | | $131.83 | $204.17 | $416.87 |