- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,548.13 / $8,912.51
| Facility | | $776.25 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,905.46 / $8,511.38 / $8,709.64
| Facility | 50 | $1,905.46 | $8,511.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,202.26
| Professional | | $398.11 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $562.34
| Professional | | $354.81 | $446.68 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $6,760.83 / $9,120.11
| Facility | | $5,623.41 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,511.38 / $10,232.93 / $13,803.84
| Facility | 50 | $8,511.38 | $10,232.93 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $933.25 / $1,023.29
| Professional | | $575.44 | $933.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $794.33
| Professional | | $338.84 | $524.81 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,168.69 / $6,456.54
| Facility | | $1,202.26 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $676.08
| Professional | | $316.23 | $457.09 | $676.08 |