- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.55 / $494.73 / $1,686.58
| Professional | | $351.55 | $494.73 | $1,686.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $703.10 / $2,529.86 / $2,723.37
| Professional | 50 | $703.10 | $2,529.86 | $2,723.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.15 / $1,699.71 / $2,250.33
| Facility | | $1,600.15 | $1,699.71 | $2,250.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.47 / $479.40 / $1,147.52
| Professional | | $250.47 | $479.40 | $1,147.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.37 / $488.88 / $1,147.52
| Professional | | $478.37 | $488.88 | $1,147.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.79 / $543.86 / $1,408.46
| Professional | | $430.79 | $543.86 | $1,408.46 |