- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,513.56
| Professional | | $436.52 | $602.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,000.00 / $3,162.28 / $6,760.83
| Professional | 50 | $1,000.00 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $1,819.70
| Professional | | $537.03 | $831.76 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $1,047.13
| Professional | | $660.69 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,445.44
| Professional | | $630.96 | $812.83 | $1,445.44 |