- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $912.01
| Professional | | $407.38 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | 50 | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $1,995.26
| Professional | | $691.83 | $812.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $891.25
| Professional | | $457.09 | $691.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,995.26
| Professional | | $912.01 | $912.01 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,778.28
| Professional | | $501.19 | $602.56 | $1,778.28 |