- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,317.64 / $12,302.69
| Facility | | $4,265.80 | $8,317.64 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 50 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $2,951.21
| Professional | | $758.58 | $1,071.52 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $2,884.03
| Professional | | $741.31 | $1,096.48 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $1,412.54
| Professional | | $891.25 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,244.36 / $11,748.98
| Facility | | $4,677.35 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $2,041.74
| Professional | | $758.58 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $10,964.78
| Facility | | $2,884.03 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,698.24
| Professional | | $724.44 | $933.25 | $1,698.24 |