- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,914.11 / $4,889.39 / $10,563.53
| Facility | | $1,914.11 | $4,889.39 | $10,563.53 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,924.46 / $2,924.46 / $10,574.79
| Facility | 50 | $2,924.46 | $2,924.46 | $10,574.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.59 / $981.96 / $1,676.47
| Professional | | $618.59 | $981.96 | $1,676.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.43 / $1,795.70 / $9,834.20
| Facility | | $1,007.43 | $1,795.70 | $9,834.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.00 / $1,983.77 / $2,865.45
| Facility | | $1,115.00 | $1,983.77 | $2,865.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |