- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.86 / $2,299.80 / $25,144.60
| Professional | | $570.86 | $2,299.80 | $25,144.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.91 / $287.91 / $606.30
| Professional | | $287.91 | $287.91 | $606.30 |
- 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
- $595.74 / $3,890.61 / $6,113.82
| Professional | | $595.74 | $3,890.61 | $6,113.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,804.29 / $5,326.01 / $7,963.65
| Professional | | $3,804.29 | $5,326.01 | $7,963.65 |