- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.38 / $596.38 / $3,811.81
| Professional | | $596.38 | $596.38 | $3,811.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.23 / $424.23 / $588.89
| Professional | | $424.23 | $424.23 | $588.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $507.66 / $507.66 / $507.66
| Professional | 50 | $507.66 | $507.66 | $507.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,651.79 / $8,651.79 / $8,651.79
| Facility | | $8,651.79 | $8,651.79 | $8,651.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.00 / $921.00 / $8,651.79
| Professional | | $921.00 | $921.00 | $8,651.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,610.87 / $5,416.31 / $9,576.58
| Professional | | $3,610.87 | $5,416.31 | $9,576.58 |