- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $870.96 / $2,630.27
| Professional | | $467.74 | $870.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | 50 | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,884.03 / $3,090.30
| Professional | | $1,778.28 | $2,884.03 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $4,677.35
| Professional | 50 | $1,479.11 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,230.27
| Professional | | $645.65 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,630.27 / $10,471.29
| Facility | | $1,995.26 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $1,995.26
| Professional | | $660.69 | $1,122.02 | $1,995.26 |