- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.69 / $594.84 / $600.51
| Professional | | $573.69 | $594.84 | $600.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.00 / $2,352.00 / $2,436.00
| Professional | | $1,455.00 | $2,352.00 | $2,436.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,182.50 / $3,528.00 / $3,654.00
| Professional | 50 | $2,182.50 | $3,528.00 | $3,654.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.84 / $688.46 / $1,002.90
| Professional | | $527.84 | $688.46 | $1,002.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.29 / $1,020.41 / $2,031.49
| Professional | | $706.29 | $1,020.41 | $2,031.49 |