- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,290.87 / $6,760.83
| Facility | | $977.24 | $2,290.87 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | 50 | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,047.13 / $2,951.21
| Professional | | $630.96 | $1,047.13 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,884.03 / $10,232.93
| Facility | | $977.24 | $2,884.03 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,445.44 / $1,949.84
| Professional | | $1,288.25 | $1,445.44 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,128.31 / $10,964.78
| Facility | | $5,128.61 | $8,128.31 | $10,964.78 |