- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,096.48 / $2,454.71
| Professional | | $323.59 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $338.84 / $1,288.25 / $4,677.35
| Professional | 50 | $338.84 | $1,288.25 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,412.54 / $2,754.23
| Professional | | $346.74 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $524.81 / $2,089.30 / $4,168.69
| Professional | 50 | $524.81 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,698.24 / $3,235.94
| Professional | | $389.05 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,778.28 / $5,011.87
| Professional | | $371.54 | $1,778.28 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,122.02 / $3,235.94
| Professional | | $323.59 | $1,122.02 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $338.84 / $562.34 / $977.24
| Professional | 50 | $338.84 | $562.34 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $3,801.89
| Professional | | $371.54 | $1,288.25 | $3,801.89 |