- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.89 / $1,698.24 / $1,778.28
| Facility | 50 | $0.89 | $1,698.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $5,754.40
| Professional | 50 | $2,754.23 | $2,754.23 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $81,283.05 / $95,499.26
| Facility | | $46,773.51 | $81,283.05 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $724.44 / $812.83
| Facility | | $645.65 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $676.08
| Facility | | $389.05 | $588.84 | $676.08 |