- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,570.88 / $8,317.64
| Facility | | $851.14 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,148.15 / $4,786.30 / $10,964.78
| Facility | 50 | $1,148.15 | $4,786.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,090.30 / $6,025.60
| Facility | | $1,318.26 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $1,698.24
| Professional | | $660.69 | $831.76 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Professional | 22 | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $8,511.38
| Facility | | $1,513.56 | $5,754.40 | $8,511.38 |