- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.78 / $5,189.72 / $11,697.02
| Facility | | $1,101.78 | $5,189.72 | $11,697.02 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,404.12 / $2,404.12 / $11,058.40
| Facility | 50 | $2,404.12 | $2,404.12 | $11,058.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.08 / $428.71 / $434.42
| Professional | | $404.08 | $428.71 | $434.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.34 / $552.54 / $659.03
| Professional | | $379.34 | $552.54 | $659.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,909.55 / $8,618.89 / $33,583.44
| Facility | | $4,909.55 | $8,618.89 | $33,583.44 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,190.50 / $8,190.50 / $8,190.50
| Facility | 50 | $8,190.50 | $8,190.50 | $8,190.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.17 / $739.17 / $739.17
| Professional | | $739.17 | $739.17 | $739.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.32 / $467.59 / $1,004.91
| Professional | | $361.32 | $467.59 | $1,004.91 |