- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $794.33 / $3,630.78
| Professional | | $549.54 | $794.33 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $831.76 / $831.76 / $1,548.82
| Professional | 50 | $831.76 | $831.76 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,388.44 / $3,548.13
| Professional | | $2,089.30 | $3,388.44 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,737.80 / $3,162.28 / $5,248.07
| Professional | 50 | $1,737.80 | $3,162.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,412.54
| Professional | | $741.31 | $977.24 | $1,412.54 |
- 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
- $741.31 / $1,288.25 / $2,344.23
| Professional | | $741.31 | $1,288.25 | $2,344.23 |