- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $1,174.90
| Professional | | $263.03 | $338.84 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $676.08
| Facility | | $616.60 | $616.60 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $616.60 / $891.25
| Professional | | $602.56 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $549.54
| Professional | | $263.03 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $891.25
| Professional | | $407.38 | $407.38 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $371.54 / $851.14
| Professional | | $239.88 | $371.54 | $851.14 |