- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.42 / $4,440.89 / $31,314.50
| Facility | | $301.42 | $4,440.89 | $31,314.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $14,213.88 / $14,213.88 / $14,213.88
| Facility | 50 | $14,213.88 | $14,213.88 | $14,213.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.93 / $927.33 / $4,440.89
| Professional | | $296.93 | $927.33 | $4,440.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.82 / $934.45 / $5,719.06
| Professional | | $361.82 | $934.45 | $5,719.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,605.59 / $19,605.59 / $22,085.06
| Facility | | $19,605.59 | $19,605.59 | $22,085.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.25 / $509.25 / $3,418.54
| Professional | | $509.25 | $509.25 | $3,418.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,158.98 / $4,652.37 / $8,093.63
| Professional | | $3,158.98 | $4,652.37 | $8,093.63 |