- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.81 / $7,074.99 / $9,662.10
| Facility | | $1,102.81 | $7,074.99 | $9,662.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,721.03 / $15,704.52 / $20,491.33
| Facility | 50 | $10,721.03 | $15,704.52 | $20,491.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $110.90 / $445.92 / $693.54
| Professional | 50 | $110.90 | $445.92 | $693.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,984.84 / $5,984.84 / $6,149.42
| Facility | | $5,984.84 | $5,984.84 | $6,149.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,970.25 / $11,970.25 / $18,760.52
| Facility | 50 | $11,970.25 | $11,970.25 | $18,760.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $910.58 / $960.68 / $6,042.29
| Professional | 50 | $910.58 | $960.68 | $6,042.29 |