- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.23 / $3,147.14 / $9,223.24
| Facility | | $186.23 | $3,147.14 | $9,223.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,367.59 / $2,847.66 / $5,224.06
| Facility | 50 | $1,367.59 | $2,847.66 | $5,224.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.51 / $234.01 / $452.04
| Professional | | $169.51 | $234.01 | $452.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $150.68 / $509.46 / $862.16
| Professional | 50 | $150.68 | $509.46 | $862.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.37 / $232.57 / $347.31
| Professional | | $188.37 | $232.57 | $347.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.31 / $128.34 / $166.06
| Professional | | $99.31 | $128.34 | $166.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.82 / $2,891.57 / $4,213.85
| Facility | | $2,237.82 | $2,891.57 | $4,213.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,356.73 / $4,337.35 / $6,320.78
| Facility | 50 | $3,356.73 | $4,337.35 | $6,320.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.61 / $273.05 / $301.20
| Professional | | $210.61 | $273.05 | $301.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,312.00 / $4,640.00
| Facility | | $1,689.00 | $2,312.00 | $4,640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.84 / $177.22 / $322.56
| Professional | | $147.84 | $177.22 | $322.56 |