- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $1,318.26
| Professional | | $398.11 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $2,570.40
| Professional | | $1,513.56 | $2,454.71 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $3,890.45
| Professional | 50 | $1,258.93 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $954.99
| Professional | | $501.19 | $645.65 | $954.99 |
- 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
- $501.19 / $912.01 / $1,621.81
| Professional | | $501.19 | $912.01 | $1,621.81 |