- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.72 / $8,802.56 / $9,901.96
| Facility | | $2,728.72 | $8,802.56 | $9,901.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,567.49 / $4,567.49 / $35,279.40
| Facility | 50 | $4,567.49 | $4,567.49 | $35,279.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.09 / $580.29 / $626.16
| Professional | | $525.09 | $580.29 | $626.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.22 / $824.53 / $988.35
| Professional | | $454.22 | $824.53 | $988.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,544.08 / $10,559.30 / $19,052.77
| Facility | | $7,544.08 | $10,559.30 | $19,052.77 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,618.91 / $8,618.91 / $8,618.91
| Facility | 50 | $8,618.91 | $8,618.91 | $8,618.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.18 / $697.16 / $1,884.69
| Professional | | $402.18 | $697.16 | $1,884.69 |