- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $2,187.76 / $7,244.36
| Facility | | $1.00 | $2,187.76 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,248.07 / $8,317.64 / $13,182.57
| Facility | 50 | $5,248.07 | $8,317.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,202.26 / $1,949.84
| Professional | | $1,047.13 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | | $2,884.03 | $2,884.03 | $2,884.03 |