- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.36 / $581.79 / $2,347.94
| Professional | | $277.36 | $581.79 | $2,347.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.94 / $888.93 / $2,618.37
| Professional | | $389.94 | $888.93 | $2,618.37 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $584.91 / $1,333.39 / $3,927.55
| Professional | 50 | $584.91 | $1,333.39 | $3,927.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.40 / $1,041.90 / $3,160.45
| Professional | | $391.40 | $1,041.90 | $3,160.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.72 / $1,225.48 / $3,438.58
| Professional | | $402.72 | $1,225.48 | $3,438.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.02 / $581.79 / $2,347.94
| Professional | | $284.02 | $581.79 | $2,347.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.92 / $2,051.67 / $3,367.85
| Professional | | $1,578.92 | $2,051.67 | $3,367.85 |