- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,677.35 / $12,022.64
| Facility | | $1,047.13 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,365.16 / $10,471.29 / $26,302.68
| Facility | 50 | $4,365.16 | $10,471.29 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $199.53 / $758.58 / $933.25
| Professional | 50 | $199.53 | $758.58 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $37,153.52 / $37,153.52
| Facility | | $37,153.52 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $245.47 / $389.05 / $794.33
| Professional | 50 | $245.47 | $389.05 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |