- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.62 / $478.40 / $532.70
| Professional | | $428.62 | $478.40 | $532.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.00 / $2,265.00 / $2,863.00
| Professional | | $1,401.00 | $2,265.00 | $2,863.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,101.50 / $3,397.50 / $4,294.50
| Professional | 50 | $2,101.50 | $3,397.50 | $4,294.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.16 / $782.82 / $1,144.11
| Professional | | $602.16 | $782.82 | $1,144.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.60 / $1,184.08 / $1,983.80
| Professional | | $673.60 | $1,184.08 | $1,983.80 |