- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $9,120.11 / $18,620.87
| Facility | | $4,677.35 | $9,120.11 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,248.07 / $8,511.38 / $20,892.96
| Facility | 50 | $5,248.07 | $8,511.38 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $537.03 / $954.99 / $7,244.36
| Professional | 50 | $537.03 | $954.99 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $501.19 / $912.01
| Professional | 50 | $446.68 | $501.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $8,511.38 / $17,782.79
| Facility | | $4,168.69 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,737.80 / $4,168.69
| Facility | | $407.38 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $20,417.38 / $25,703.96
| Facility | | $8,709.64 | $20,417.38 | $25,703.96 |