- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.66 / $4,952.87 / $12,311.62
| Facility | | $3,206.66 | $4,952.87 | $12,311.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,057.36 / $3,057.36 / $4,952.33
| Facility | 50 | $3,057.36 | $3,057.36 | $4,952.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.77 / $442.48 / $857.66
| Professional | | $364.77 | $442.48 | $857.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.76 / $616.07 / $890.21
| Professional | | $491.76 | $616.07 | $890.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.11 / $839.49 / $1,244.52
| Professional | | $568.11 | $839.49 | $1,244.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.61 / $717.23 / $1,116.01
| Professional | | $581.61 | $717.23 | $1,116.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.66 / $8,025.88 / $13,881.65
| Facility | | $3,206.66 | $8,025.88 | $13,881.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,057.36 / $3,057.36 / $4,952.33
| Facility | 50 | $3,057.36 | $3,057.36 | $4,952.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.76 / $442.48 / $907.04
| Professional | | $364.76 | $442.48 | $907.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.54 / $767.73 / $1,144.64
| Professional | | $541.54 | $767.73 | $1,144.64 |