- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $954.99 / $2,754.23
| Professional | | $309.03 | $954.99 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $489.78 / $549.54 / $724.44
| Professional | 50 | $489.78 | $549.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $4,265.80
| Professional | | $891.25 | $1,023.29 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $1,258.93 / $6,456.54
| Professional | 50 | $741.31 | $1,258.93 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,148.15 / $3,467.37
| Professional | | $426.58 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,918.31 / $25,703.96
| Facility | | $4,677.35 | $6,918.31 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,412.54 / $5,128.61
| Professional | | $537.03 | $1,412.54 | $5,128.61 |