- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $5,754.40 / $10,471.29
| Facility | | $891.25 | $5,754.40 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,309.57 / $7,943.28 / $11,748.98
| Facility | 50 | $6,309.57 | $7,943.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $2,818.38
| Professional | | $457.09 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $831.76 / $1,995.26
| Professional | | $457.09 | $831.76 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $891.25 / $1,412.54
| Professional | | $794.33 | $891.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $16,595.87
| Facility | | $6,760.83 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $794.33 / $1,479.11
| Professional | | $398.11 | $794.33 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $10,964.78
| Facility | | $2,951.21 | $6,606.93 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $537.03 / $1,230.27
| Professional | | $281.84 | $537.03 | $1,230.27 |