- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.15 / $1,710.18 / $14,629.80
| Professional | | $423.15 | $1,710.18 | $14,629.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.06 / $345.06 / $345.06
| Professional | | $345.06 | $345.06 | $345.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,866.19 / $9,522.66 / $12,811.02
| Facility | | $7,866.19 | $9,522.66 | $12,811.02 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,799.29 / $14,283.98 / $19,216.53
| Facility | 50 | $11,799.29 | $14,283.98 | $19,216.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.65 / $2,272.77 / $3,571.50
| Professional | | $498.65 | $2,272.77 | $3,571.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,222.21 / $2,962.96 / $4,651.85
| Professional | | $2,222.21 | $2,962.96 | $4,651.85 |