- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.92 / $775.53 / $4,159.88
| Professional | | $196.92 | $775.53 | $4,159.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.00 / $198.00 / $198.00
| Professional | | $198.00 | $198.00 | $198.00 |
- 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
- $221.48 / $640.87 / $1,007.08
| Professional | | $221.48 | $640.87 | $1,007.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.17 / $805.25 / $1,227.04
| Professional | | $575.17 | $805.25 | $1,227.04 |