- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,172.28 / $10,173.51 / $11,507.92
| Facility | | $10,172.28 | $10,173.51 | $11,507.92 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $20,347.02 / $20,347.02 / $21,022.30
| Facility | 50 | $20,347.02 | $20,347.02 | $21,022.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.25 / $652.21 / $3,041.88
| Professional | | $312.25 | $652.21 | $3,041.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $156.31 / $234.47 / $271.20
| Professional | 50 | $156.31 | $234.47 | $271.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.53 / $1,007.71 / $3,276.31
| Professional | | $438.53 | $1,007.71 | $3,276.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $657.79 / $1,511.56 / $4,914.46
| Professional | 50 | $657.79 | $1,511.56 | $4,914.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.89 / $1,176.59 / $3,857.95
| Professional | | $436.89 | $1,176.59 | $3,857.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.77 / $1,374.74 / $4,302.62
| Professional | | $451.77 | $1,374.74 | $4,302.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,172.28 / $10,173.51 / $11,507.92
| Facility | | $10,172.28 | $10,173.51 | $11,507.92 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $20,347.02 / $21,022.30 / $28,946.24
| Facility | 50 | $20,347.02 | $21,022.30 | $28,946.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.81 / $652.21 / $3,041.88
| Professional | | $347.81 | $652.21 | $3,041.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $156.31 / $234.47 / $271.20
| Professional | 50 | $156.31 | $234.47 | $271.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.97 / $2,630.35 / $4,168.72
| Professional | | $1,708.97 | $2,630.35 | $4,168.72 |