- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.28 / $4,604.83 / $8,042.03
| Facility | | $1,586.28 | $4,604.83 | $8,042.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,458.60 / $4,143.39 / $10,554.27
| Facility | 50 | $2,458.60 | $4,143.39 | $10,554.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.97 / $319.14 / $592.17
| Professional | | $166.97 | $319.14 | $592.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.32 / $553.54 / $8,972.49
| Facility | | $368.32 | $553.54 | $8,972.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.00 / $543.35 / $3,054.91
| Facility | | $366.00 | $543.35 | $3,054.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |