- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $707.95 / $1,698.24
| Professional | | $537.03 | $707.95 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,412.54 / $1,548.82 / $4,570.88
| Professional | 50 | $1,412.54 | $1,548.82 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $3,019.95
| Professional | | $1,202.26 | $1,202.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,174.90 / $1,862.09
| Professional | | $537.03 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $2,754.23
| Professional | | $812.83 | $1,122.02 | $2,754.23 |