- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.73 / $9,849.39 / $10,599.81
| Facility | | $1,303.73 | $9,849.39 | $10,599.81 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,608.69 / $10,608.69 / $10,902.16
| Facility | 50 | $10,608.69 | $10,608.69 | $10,902.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.55 / $442.83 / $507.29
| Professional | | $371.55 | $442.83 | $507.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.20 / $585.71 / $804.68
| Professional | | $391.20 | $585.71 | $804.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,132.00 / $8,703.12 / $10,077.21
| Facility | | $6,132.00 | $8,703.12 | $10,077.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,693.73 / $9,693.73 / $9,693.73
| Facility | 50 | $9,693.73 | $9,693.73 | $9,693.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.72 / $559.29 / $1,589.68
| Professional | | $437.72 | $559.29 | $1,589.68 |