- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,032.04 / $9,419.91 / $10,986.07
| Facility | | $9,032.04 | $9,419.91 | $10,986.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $20,347.02 / $21,022.30 / $23,015.84
| Facility | 50 | $20,347.02 | $21,022.30 | $23,015.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $233.93 / $467.85 / $546.29
| Professional | 50 | $233.93 | $467.85 | $546.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $662.14 / $1,507.26 / $5,040.64
| Professional | 50 | $662.14 | $1,507.26 | $5,040.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,032.04 / $9,419.91 / $10,986.07
| Facility | | $9,032.04 | $9,419.91 | $10,986.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $18,064.07 / $20,347.02 / $23,015.84
| Facility | 50 | $18,064.07 | $20,347.02 | $23,015.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $233.93 / $467.85 / $546.29
| Professional | 50 | $233.93 | $467.85 | $546.29 |