- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,244.36 / $11,748.98
| Facility | | $4,365.16 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $10,715.19
| Facility | 50 | $2,511.89 | $2,951.21 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,621.81
| Professional | | $467.74 | $630.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $354.81 / $1,071.52 / $2,041.74
| Professional | 50 | $354.81 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $645.65 / $1,621.81
| Professional | | $407.38 | $645.65 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,071.52
| Professional | | $575.44 | $812.83 | $1,071.52 |
- 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
- $416.87 / $741.31 / $1,288.25
| Professional | | $416.87 | $741.31 | $1,288.25 |
- 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
- $389.05 / $602.56 / $1,148.15
| Professional | | $389.05 | $602.56 | $1,148.15 |