- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.66 / $2,087.42 / $21,714.70
| Professional | | $521.66 | $2,087.42 | $21,714.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.02 / $361.94 / $2,730.10
| Professional | | $262.02 | $361.94 | $2,730.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $591.79 / $591.79 / $591.79
| Professional | 50 | $591.79 | $591.79 | $591.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,640.79 / $17,723.84 / $23,844.24
| Facility | | $14,640.79 | $17,723.84 | $23,844.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $21,961.18 / $26,585.77 / $35,766.37
| Facility | 50 | $21,961.18 | $26,585.77 | $35,766.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.22 / $3,735.92 / $5,870.73
| Professional | | $774.22 | $3,735.92 | $5,870.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,009.06 / $4,212.68 / $6,419.33
| Professional | | $3,009.06 | $4,212.68 | $6,419.33 |