- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $10,715.19
| Facility | | $1,862.09 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | 50 | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $17,378.01
| Facility | | $4,570.88 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,238.72 / $7,079.46
| Facility | | $812.83 | $2,238.72 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $2,238.72
| Professional | | $436.52 | $630.96 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,317.64 / $15,848.93
| Facility | | $3,548.13 | $8,317.64 | $15,848.93 |