- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $501.19 / $812.83
| Professional | | $234.42 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,348.96 / $1,412.54
| Professional | | $831.76 | $1,348.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $691.83 / $1,318.26 / $2,137.96
| Professional | 50 | $691.83 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $575.44
| Professional | | $302.00 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $794.33 / $3,235.94
| Facility | | $467.74 | $794.33 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $1,230.27
| Professional | | $398.11 | $524.81 | $1,230.27 |