- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.68 / $1,884.57 / $17,612.40
| Professional | | $468.68 | $1,884.57 | $17,612.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.65 / $248.65 / $248.65
| Professional | | $248.65 | $248.65 | $248.65 |
- 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
- $474.56 / $2,732.30 / $4,293.60
| Professional | | $474.56 | $2,732.30 | $4,293.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,643.11 / $3,700.36 / $5,532.92
| Professional | | $2,643.11 | $3,700.36 | $5,532.92 |