- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,753.50 / $8,802.56 / $15,913.63
| Facility | | $4,753.50 | $8,802.56 | $15,913.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,878.42 / $13,250.62 / $13,250.62
| Facility | 50 | $7,878.42 | $13,250.62 | $13,250.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.82 / $418.00 / $501.59
| Professional | | $410.82 | $418.00 | $501.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.32 / $522.14 / $723.97
| Professional | | $373.32 | $522.14 | $723.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,469.26 / $8,368.87 / $24,741.54
| Facility | | $6,469.26 | $8,368.87 | $24,741.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,829.54 / $11,878.79 / $23,795.58
| Facility | 50 | $8,829.54 | $11,878.79 | $23,795.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.31 / $496.83 / $945.60
| Professional | | $415.31 | $496.83 | $945.60 |